Healthcare Provider Details

I. General information

NPI: 1679488266
Provider Name (Legal Business Name): SREY IM-LY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SREYTOUCH IM-LY PMHNP-BC

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 MARION AVE
PLANTSVILLE CT
06479-1441
US

IV. Provider business mailing address

775 MARION AVE
PLANTSVILLE CT
06479-1441
US

V. Phone/Fax

Practice location:
  • Phone: 203-258-6974
  • Fax:
Mailing address:
  • Phone: 203-258-6974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number18070
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: