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General NPI Number Information
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NPI Number | 1316161193
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Entity Type | Organization
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Legal Business Name | WATERBURY PSYCHIATRIC ASSOCIATES, P.C.
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 133 SCOVILL ST SUITE # 201
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City | WATERBURY
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State | CT
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Zip | 06706-1127
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Country | US
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Telephone | 203-597-0575
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Fax | 203-757-4105
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Provider Business Mailing Address
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Address Line | 133 SCOVILL ST SUITE # 201
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City | WATERBURY
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State | CT
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Zip | 06706-1127
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Country | US
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Telephone | 203-597-0575
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Fax | 203-757-4105
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Authorized Official
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Title or Position | PRESIDENT
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Name | AZHAR IMAM
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Credential | M.D.
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Telephone | 203-597-0575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 042814
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License Number State | CT
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