Healthcare Provider Details

I. General information

NPI: 1912569450
Provider Name (Legal Business Name): STEPHEN J BERES APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 SILAS DEANE HWY STE 101
WETHERSFIELD CT
06109-4363
US

IV. Provider business mailing address

1260 SILAS DEANE HWY STE 101
WETHERSFIELD CT
06109-4363
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-7550
  • Fax:
Mailing address:
  • Phone: 860-545-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number144369
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8297
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: