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General NPI Number Information
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NPI Number | 1134407174
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Entity Type | Organization
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Legal Business Name | COMPASSIONATE PSYCHIATRIC CARE, LLC
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 02/17/2012
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Provider Practice Location Address
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Address Line | 60 BOSTON POST RD SECOND FLOOR
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City | MADISON
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State | CT
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Zip | 06443-2157
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Country | US
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Telephone | 203-421-6156
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Fax | 203-421-6157
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Provider Business Mailing Address
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Address Line | 60 BOSTON POST RD SECOND FLOOR
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City | MADISON
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State | CT
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Zip | 06443-2157
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Country | US
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Telephone | 203-421-6156
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Fax | 203-421-6157
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Authorized Official
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Title or Position | APRN-BC
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Name | SHARON E DURIVAGE
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Credential | APRN-BC
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Telephone | 203-421-6156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 004454
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License Number State | CT
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