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General NPI Number Information
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NPI Number | 1316501042
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Entity Type | Organization
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Legal Business Name | GENERATIONS PSYCHIATRY SERVICES PLLC
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Dates
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Enumeration Date | 04/29/2019
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Last Update Date | 04/29/2019
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Provider Practice Location Address
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Address Line | 420 E MAIN ST STE 5
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City | BRANFORD
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State | CT
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Zip | 06405-2941
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Country | US
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Telephone | 203-433-2550
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Fax | 949-404-6557
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Provider Business Mailing Address
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Address Line | 420 E MAIN ST STE 5
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City | BRANFORD
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State | CT
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Zip | 06405-2941
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Country | US
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Telephone | 203-433-2550
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Fax | 949-404-6557
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Authorized Official
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Title or Position | OWNER
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Name | RYAN JOHN DILLON
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Credential | APRN
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Telephone | 203-215-7344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 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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