Healthcare Provider Details

I. General information

NPI: 1801728415
Provider Name (Legal Business Name): RAVENSWOOD PSYCHIATRIC SERVICES, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E MAIN ST STE 4
VERNON CT
06066-3352
US

IV. Provider business mailing address

195 DAVIS RD
STORRS MANSFIELD CT
06268-2523
US

V. Phone/Fax

Practice location:
  • Phone: 860-341-6885
  • Fax: 860-703-3903
Mailing address:
  • Phone: 860-218-0393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARLENE M DOLAT
Title or Position: APRN
Credential: PMHNP-BC, FNP-BC
Phone: 860-218-0393