=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316869985
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CT BIPOC MENTAL HEALTH & WELLNESS ALLIANCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2026
-----------------------------------------------------
Last Update Date | 07/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 STATE ST STE 308
-----------------------------------------------------
City | NEW LONDON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06320-6112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-373-6077
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 STATE ST STE 308
-----------------------------------------------------
City | NEW LONDON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06320-6112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-373-6077
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | DR. JANELLE POSEY-GREEN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 860-373-6077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------