Healthcare Provider Details

I. General information

NPI: 1811778988
Provider Name (Legal Business Name): OPTUM BEHAVIORAL CARE OF CONNECTICUT, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 WALNUT ST STE 802
PHILADELPHIA PA
19102-4008
US

IV. Provider business mailing address

67 BURNSIDE AVE
EAST HARTFORD CT
06108-3408
US

V. Phone/Fax

Practice location:
  • Phone: 610-544-2110
  • Fax:
Mailing address:
  • Phone: 952-246-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA BRONSON
Title or Position: CEO
Credential:
Phone: 704-506-6267