Healthcare Provider Details

I. General information

NPI: 1902739998
Provider Name (Legal Business Name): CONNECTICUT PSYCHIATRIC NURSE PRACTITIONER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LIBERTY SQ STE 301
NEW BRITAIN CT
06051-2637
US

IV. Provider business mailing address

1 LIBERTY SQ STE 301
NEW BRITAIN CT
06051-2637
US

V. Phone/Fax

Practice location:
  • Phone: 860-893-3131
  • Fax: 860-777-0143
Mailing address:
  • Phone: 860-893-3131
  • Fax: 860-777-0143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. NANCY CONCEPCION
Title or Position: OWNER
Credential: APRN
Phone: 860-893-3131