Healthcare Provider Details

I. General information

NPI: 1255236527
Provider Name (Legal Business Name): BESPOKE THERAPY CT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MERWIN AVE SUITE D1
MILFORD CT
06460
US

IV. Provider business mailing address

167 CHERRY ST STE 147
MILFORD CT
06460-3466
US

V. Phone/Fax

Practice location:
  • Phone: 859-547-2012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JUSTIN BRANHAM
Title or Position: FOUNDER & CEO
Credential: APRN
Phone: 859-547-2012