=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346973617
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALTRUISM PSYCHCARE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2022
-----------------------------------------------------
Last Update Date | 07/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 BRIAN LN
-----------------------------------------------------
City | AVON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06001-3518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-712-1314
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 BRIAN LN
-----------------------------------------------------
City | AVON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06001-3518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-712-1314
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | APRN
-----------------------------------------------------
Name | FURNE SUSAN CARRIER-VALENTINE
-----------------------------------------------------
Credential | PMHNP
-----------------------------------------------------
Telephone | 860-712-1314
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------