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General NPI Number Information
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NPI Number | 1871943514
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Entity Type | Organization
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Legal Business Name | JP BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 45 S MAIN ST SUITE 70
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2441
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Country | US
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Telephone | 516-205-6080
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Fax |
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Provider Business Mailing Address
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Address Line | 129 PENN DR
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1041
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Country | US
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Telephone | 516-205-6080
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Fax |
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Authorized Official
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Title or Position | C0-OWNER- CLINICAL PSYCHOLOGIST
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Name | PURVI SHAH VANDERPLOEG
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Credential | PH.D
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Telephone | 516-205-6080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 002878
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License Number State | CT
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