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General NPI Number Information
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NPI Number | 1417773094
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Entity Type | Organization
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Legal Business Name | PHOENIX RISING PSYCHIATRIC SERVICES PLLC
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Dates
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Enumeration Date | 11/27/2024
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Last Update Date | 11/27/2024
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Provider Practice Location 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 | 203-632-6239
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4675
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City | WALLINGFORD
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State | CT
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Zip | 06492-7568
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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 | DNP, PMHNP-BC, APRN
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Name | JENNIFER RICHELLO
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Credential | DNP, PMHNP-BC, APRN
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Telephone | 203-632-6239
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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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