Healthcare Provider Details

I. General information

NPI: 1588215156
Provider Name (Legal Business Name): RISE UP BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 WESTBURY PARK RD
WATERTOWN CT
06795-2779
US

IV. Provider business mailing address

84 PORTLAND ST
OAKVILLE CT
06779-1032
US

V. Phone/Fax

Practice location:
  • Phone: 860-484-3781
  • Fax:
Mailing address:
  • Phone: 203-217-1455
  • 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: HEATHER HUMPHREY
Title or Position: SOLE MEMBER
Credential: APRN
Phone: 203-217-1455