Healthcare Provider Details
I. General information
NPI: 1265720163
Provider Name (Legal Business Name): NEWINGTON BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/13/2011
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1268 MAIN ST SUITE 107
NEWINGTON CT
06111-3038
US
IV. Provider business mailing address
93 ROCKLEDGE DR
NEWINGTON CT
06111-5152
US
V. Phone/Fax
- Phone: 860-667-3965
- Fax: 866-514-0409
- Phone: 203-887-5950
- Fax: 866-514-0409
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QM0850X |
| Taxonomy | Adult Mental Health Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
GABRIEL
O
ARIMORO
Title or Position: PSYCHIATRIST
Credential: M.D
Phone: 203-887-5950