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General NPI Number Information
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NPI Number | 1750275434
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Entity Type | Organization
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Legal Business Name | BARDWELL BEHAVIORAL, LLC
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 90 APPLETREE LN
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City | PORTLAND
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State | CT
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Zip | 06480-1072
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Country | US
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Telephone | 860-398-9118
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Fax | 860-740-4485
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Provider Business Mailing Address
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Address Line | 5 PROGRESS DR
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City | CROMWELL
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State | CT
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Zip | 06416-1035
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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 | OWNER/FOUNDER
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Name | REBEKAH ALIZAH DOWEYKO
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Credential | LPC, LMHC, LCMHC
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Telephone | 561-504-4373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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