=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326984329
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEASONS BEHAVIORAL HEALTH GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2026
-----------------------------------------------------
Last Update Date | 04/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 HILLCREST AVE
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06457-5322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-784-7659
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2550 ALBANY AVE # 1120
-----------------------------------------------------
City | WEST HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06117-2335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-784-7659
-----------------------------------------------------
Fax | 860-935-6272
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PMHNP
-----------------------------------------------------
Name | CARLY BENDZANS
-----------------------------------------------------
Credential | PMHNP, CNM
-----------------------------------------------------
Telephone | 508-272-2668
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------