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General NPI Number Information
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NPI Number | 1609672518
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Entity Type | Organization
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Legal Business Name | VIAREPOSE MENTAL HEALTH & WELLNESS LLC
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 843 MAIN ST STE 15
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City | MANCHESTER
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State | CT
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Zip | 06040-6020
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Country | US
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Telephone | 860-999-6248
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Fax |
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Provider Business Mailing Address
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Address Line | 35 TALCOTTVILLE RD STE 10
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City | VERNON ROCKVILLE
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State | CT
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Zip | 06066-5261
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Country | US
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Telephone | 860-374-8538
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Fax |
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Authorized Official
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Title or Position | NP
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Name | MARVIA MCDONALD-DIAS
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Credential |
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Telephone | 860-374-8538
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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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