=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376307413
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DBI BEHAVIORAL HEALTH SOLUTIONS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2024
-----------------------------------------------------
Last Update Date | 02/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 153 ASHWOOD TER
-----------------------------------------------------
City | STRATFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06614-1132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-551-7210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 153 ASHWOOD TER
-----------------------------------------------------
City | STRATFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06614-1132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-551-7210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PMHNP-BC, FNP-BC
-----------------------------------------------------
Name | MRS. DONALDA ISIDORE
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 203-551-7210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------