Healthcare Provider Details

I. General information

NPI: 1710718325
Provider Name (Legal Business Name): TENACITY BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 PROSPECT AVE STE 184
WEST HARTFORD CT
06105-2965
US

IV. Provider business mailing address

557 PROSPECT AVE STE 184
WEST HARTFORD CT
06105-2965
US

V. Phone/Fax

Practice location:
  • Phone: 860-321-6342
  • Fax: 860-579-6397
Mailing address:
  • Phone: 860-321-6342
  • Fax: 860-579-6397

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: MS. TIFFANY OTTO
Title or Position: MANAGER
Credential: APRN
Phone: 860-713-3637