=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063206209
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MW PSYCHIATRY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2025
-----------------------------------------------------
Last Update Date | 04/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 RYANS WAY
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06013-1822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-518-7569
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 ALBANY TPKE # 1036
-----------------------------------------------------
City | WEST SIMSBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06092-2903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-518-7569
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING SPECIALIST
-----------------------------------------------------
Name | BREANNA ARMENTO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-836-1363
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------