Healthcare Provider Details

I. General information

NPI: 1417849621
Provider Name (Legal Business Name): BALANCED PATH MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

869 ORANGE ST APT 3W
NEW HAVEN CT
06511-2562
US

IV. Provider business mailing address

869 ORANGE ST APT 3W
NEW HAVEN CT
06511-2562
US

V. Phone/Fax

Practice location:
  • Phone: 646-519-1853
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MAJA WITWICKA
Title or Position: OWNER
Credential: PMHNP
Phone: 646-519-1853