Healthcare Provider Details

I. General information

NPI: 1255548590
Provider Name (Legal Business Name): MEDOPTIONS BEHAVIORAL HEALTH ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 RESEARCH PKWY
OLD SAYBROOK CT
06475-4214
US

IV. Provider business mailing address

20 RESEARCH PKWY
OLD SAYBROOK CT
06475-4214
US

V. Phone/Fax

Practice location:
  • Phone: 860-510-0888
  • Fax: 860-510-0020
Mailing address:
  • Phone: 860-510-0888
  • Fax: 860-510-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLY JOHNSON
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 860-510-0888