Healthcare Provider Details

I. General information

NPI: 1154234227
Provider Name (Legal Business Name): BLUE ARCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 LONG RIDGE RD FL 3
REDDING CT
06896-1111
US

IV. Provider business mailing address

28 1ST ST
STAMFORD CT
06905-5117
US

V. Phone/Fax

Practice location:
  • Phone: 646-226-7306
  • Fax:
Mailing address:
  • Phone: 646-226-7306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: LINA LEE
Title or Position: CEO
Credential:
Phone: 646-226-7306