Healthcare Provider Details

I. General information

NPI: 1528326808
Provider Name (Legal Business Name): CONNECTICUT PSYCHIATRIC & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 04/17/2024
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRADLEY RD SUITE 905
WOODBRIDGE CT
06525-2285
US

IV. Provider business mailing address

1 BRADLEY RD STE 404
WOODBRIDGE CT
06525-2235
US

V. Phone/Fax

Practice location:
  • Phone: 203-298-9005
  • Fax: 203-298-9006
Mailing address:
  • Phone: 203-298-9005
  • Fax: 203-535-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number045572
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number045572
License Number StateCT

VIII. Authorized Official

Name: VANESSA L ACAMPORA
Title or Position: MANAGER
Credential:
Phone: 203-298-9005