Healthcare Provider Details

I. General information

NPI: 1033443882
Provider Name (Legal Business Name): PSYCHIATRIC CARE CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 PARK ST SUITE 1G
NEW HAVEN CT
06511-5412
US

IV. Provider business mailing address

111 PARK ST SUITE 1G
NEW HAVEN CT
06511-5412
US

V. Phone/Fax

Practice location:
  • Phone: 203-562-0223
  • Fax: 203-777-4226
Mailing address:
  • Phone: 203-562-0223
  • Fax: 203-777-4226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number036772
License Number StateCT

VIII. Authorized Official

Name: KISHORCHANDRA R GONSAI
Title or Position: PRESIDENT
Credential: MD
Phone: 203-562-0223