Healthcare Provider Details

I. General information

NPI: 1023929718
Provider Name (Legal Business Name): KETAMEND THERAPEUTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 EAST AVE STE 114-116
NORWALK CT
06851-4920
US

IV. Provider business mailing address

6 STEEPLE TOP RD
NORWALK CT
06853-1039
US

V. Phone/Fax

Practice location:
  • Phone: 203-989-4608
  • Fax:
Mailing address:
  • Phone: 203-989-4608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC NICHOLAS CHRISTIE
Title or Position: OWNER / MEDICAL DIRECTOR
Credential: DO
Phone: 203-989-4608