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General NPI Number Information
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NPI Number | 1730626235
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Entity Type | Organization
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Legal Business Name | HALF FULL PSYCHIATRY LLC
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Dates
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Enumeration Date | 01/23/2017
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Last Update Date | 02/07/2019
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Provider Practice Location Address
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Address Line | 39 NEW LONDON TPKE STE 230F
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City | GLASTONBURY
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State | CT
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Zip | 06033
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Country | US
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Telephone | 860-251-9713
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Fax | 844-831-5028
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Provider Business Mailing Address
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Address Line | 66 CADBURY LN
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-2269
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTITIONER
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Name | MR. AMER NABIL
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Credential | PMHNP
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Telephone | 860-251-9713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 006469
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License Number State | CT
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