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General NPI Number Information
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NPI Number | 1467982504
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC ALLIANCE OF CONNECTICUT, LLC
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Dates
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Enumeration Date | 06/12/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 174 SOUTH RD STE 125
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City | ENFIELD
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State | CT
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Zip | 06082-4414
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Country | US
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Telephone | 860-966-1004
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Fax | 860-788-4090
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Provider Business Mailing Address
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Address Line | 174 SOUTH RD STE 125
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City | ENFIELD
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State | CT
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Zip | 06082-4414
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Country | US
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Telephone | 860-966-1004
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Fax | 860-788-4090
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Authorized Official
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Title or Position | OWNER
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Name | MR. JULIO RENE DURAN JR.
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Credential | PMHNP
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Telephone | 860-966-1004
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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 | 7027
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License Number State | CT
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