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General NPI Number Information
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NPI Number | 1356010243
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Entity Type | Organization
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Legal Business Name | FIVE CORNERS BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 09/13/2021
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 115 BIRDSEYE RD
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City | FARMINGTON
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State | CT
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Zip | 06032-2481
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Country | US
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Telephone | 860-205-7416
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Fax | 860-678-9306
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Provider Business Mailing Address
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Address Line | 115 BIRDSEYE RD
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City | FARMINGTON
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State | CT
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Zip | 06032-2481
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Country | US
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Telephone | 860-205-7416
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Fax | 860-678-9308
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Authorized Official
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Title or Position | NURSE PRACTIOIONTER
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Name | MS. MARTHA J STEWART
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Credential | APRN
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Telephone | 860-205-7416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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