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General NPI Number Information
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NPI Number | 1295695039
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Entity Type | Organization
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Legal Business Name | MANCHESTER MEMORIAL HOSPITAL, INC.
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Dates
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Enumeration Date | 11/14/2025
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 71 HAYNES ST
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City | MANCHESTER
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State | CT
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Zip | 06040-4188
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Country | US
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Telephone | 860-646-1222
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Fax |
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Provider Business Mailing Address
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Address Line | 1290 SILAS DEANE HWY STE 102
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City | WETHERSFIELD
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State | CT
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Zip | 06109-4337
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Country | US
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Telephone | 860-972-3075
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Fax | 860-972-7040
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Authorized Official
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Title or Position | SR VICE PRESIDENT
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Name | GERALD BOISVERT
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Credential |
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Telephone | 860-263-4190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number |
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License Number State |
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