Healthcare Provider Details

I. General information

NPI: 1316869985
Provider Name (Legal Business Name): CT BIPOC MENTAL HEALTH & WELLNESS ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STATE ST STE 308
NEW LONDON CT
06320-6112
US

IV. Provider business mailing address

300 STATE ST STE 308
NEW LONDON CT
06320-6112
US

V. Phone/Fax

Practice location:
  • Phone: 860-373-6077
  • Fax:
Mailing address:
  • Phone: 860-373-6077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JANELLE POSEY-GREEN
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 860-373-6077