Healthcare Provider Details

I. General information

NPI: 1144130204
Provider Name (Legal Business Name): JUSTIN ROBERT BARTOLOMEO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 POST RD E STE 201
WESTPORT CT
06880-5528
US

IV. Provider business mailing address

37 SMITH ST
DERBY CT
06418-1215
US

V. Phone/Fax

Practice location:
  • Phone: 203-255-0301
  • Fax:
Mailing address:
  • Phone: 203-727-0377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: