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General NPI Number Information
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NPI Number | 1588215156
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Entity Type | Organization
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Legal Business Name | RISE UP BEHAVIORAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 76 WESTBURY PARK RD
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City | WATERTOWN
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State | CT
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Zip | 06795-2779
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Country | US
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Telephone | 860-484-3781
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Fax |
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Provider Business Mailing Address
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Address Line | 84 PORTLAND ST
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City | OAKVILLE
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State | CT
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Zip | 06779-1032
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Country | US
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Telephone | 203-217-1455
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | HEATHER HUMPHREY
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Credential | APRN
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Telephone | 203-217-1455
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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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