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General NPI Number Information
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NPI Number | 1750973152
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Entity Type | Organization
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Legal Business Name | MAGNOLIA BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 02/07/2021
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 762 BOSTON POST RD FL 2
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City | MADISON
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State | CT
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Zip | 06443-3047
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Country | US
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Telephone | 203-903-9728
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Fax | 844-440-2333
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Provider Business Mailing Address
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Address Line | 50 BREWERY ST UNIT 9138
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City | NEW HAVEN
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State | CT
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Zip | 06511-5954
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Country | US
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Telephone | 203-903-9797
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Fax | 844-440-2333
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Authorized Official
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Title or Position | OWNER
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Name | JESSIKA DUCHARME BRASSEAUX
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Credential | APRN, PMHNP
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Telephone | 203-903-9797
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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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