=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437985629
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE BRAIN BRIDGE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2024
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 RESEARCH DR STE 402
-----------------------------------------------------
City | SHELTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06484-6242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-513-9456
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 RESEARCH DR
-----------------------------------------------------
City | SHELTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06484-6280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-513-9456
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF ADMINISTRATION
-----------------------------------------------------
Name | JOANNE MILORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-513-9456
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------