Healthcare Provider Details

I. General information

NPI: 1700210549
Provider Name (Legal Business Name): NEW LEAF INSTITUTE OF BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 ELM ST SUITE 104
ROCKY HILL CT
06067-1849
US

IV. Provider business mailing address

1090 ELM ST SUITE 104
ROCKY HILL CT
06067-1849
US

V. Phone/Fax

Practice location:
  • Phone: 860-384-9477
  • Fax:
Mailing address:
  • Phone: 860-384-9477
  • Fax:

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number008058
License Number StateCT

VIII. Authorized Official

Name: ENKELIDA GJUSHI
Title or Position: OWNER
Credential:
Phone: 860-384-9477