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General NPI Number Information
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NPI Number | 1407375363
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Entity Type | Organization
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Legal Business Name | CONNECTICUT GERIATRIC NEUROPSYCHIATRY, LLC
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Dates
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Enumeration Date | 09/12/2017
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Last Update Date | 03/23/2018
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Provider Practice Location Address
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Address Line | 558 HOPMEADOW ST
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City | SIMSBURY
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State | CT
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Zip | 06070-2415
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Country | US
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Telephone | 860-371-0064
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Fax |
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Provider Business Mailing Address
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Address Line | 542 HOPMEADOW ST PMB 138
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City | SIMSBURY
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State | CT
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Zip | 06070-5405
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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 | COWNER
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Name | MARYANNE STRINDBERG
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Credential | APRN
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Telephone | 860-990-4673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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