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General NPI Number Information
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NPI Number | 1508546524
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Entity Type | Organization
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Legal Business Name | GLASTONBURY PSYCHIATRIC CARE LLC
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 200 OAK ST
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City | GLASTONBURY
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State | CT
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Zip | 06033-4805
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Country | US
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Telephone | 959-867-9880
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Fax |
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Provider Business Mailing Address
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Address Line | 90 GRANDVIEW DR
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City | GLASTONBURY
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State | CT
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Zip | 06033-3931
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Country | US
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Telephone | 201-660-4384
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. SARAH JANE DE ASIS VARGAS
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Credential | MD
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Telephone | 201-660-4384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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