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General NPI Number Information
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NPI Number | 1356215503
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Entity Type | Organization
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Legal Business Name | KETAMEND WELLNESS
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Dates
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Enumeration Date | 10/01/2025
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 6 STEEPLE TOP RD
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City | NORWALK
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State | CT
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Zip | 06853-1039
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Country | US
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Telephone | 203-450-9116
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Fax |
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Provider Business Mailing Address
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Address Line | 2389 MAIN ST STE 100
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City | GLASTONBURY
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State | CT
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Zip | 06033-4617
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | ERIC NICHOLAS CHRISTIE
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Credential | DO
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Telephone | 203-450-9116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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