Healthcare Provider Details

I. General information

NPI: 1568530319
Provider Name (Legal Business Name): PERCEPTION PROGRAMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 MAIN ST
WILLIMANTIC CT
06226-2442
US

IV. Provider business mailing address

842 MAIN ST
WILLIMANTIC CT
06226-2442
US

V. Phone/Fax

Practice location:
  • Phone: 860-450-7122
  • Fax: 860-450-7152
Mailing address:
  • Phone: 860-450-7122
  • Fax: 860-450-7127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DAN GERWIEN
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 860-450-7122