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General NPI Number Information
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NPI Number | 1063785814
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Entity Type | Organization
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Legal Business Name | THE HEALTHY MIND PSYCHIATRIC SERVICES PC
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 900 STRAITS TPKE SUITE D
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City | MIDDLEBURY
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State | CT
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Zip | 06762-2800
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Country | US
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Telephone | 203-270-5575
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Fax | 203-883-0365
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Provider Business Mailing Address
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Address Line | 900 STRAITS TPKE SUITE D
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City | MIDDLEBURY
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State | CT
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Zip | 06762-2800
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Country | US
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Telephone | 203-270-5575
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Fax | 203-883-0365
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | SHAH NAWAZ
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Credential | MD
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Telephone | 203-270-5575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 039250
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 039250
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 039250
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 039250
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 039250
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License Number State | CT
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Taxonomy #6
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 039250
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License Number State | CT
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Taxonomy #7
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 039250
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License Number State | CT
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