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NPI Code Detail

MEDICARE: MEDOP BEHAVIORAL HEALTH ASSOCIATES PC

MEDICARE: MEDOP BEHAVIORAL HEALTH ASSOCIATES PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist
21041C0700XClinical Social Worker
32084P0800XPsychiatry Physician
42084P0805XGeriatric Psychiatry Physician
5363AM0700XMedical Physician Assistant
6363L00000XNurse Practitioner
7363LA2100XAcute Care Nurse Practitioner
8363LA2200XAdult Health Nurse Practitioner
9363LF0000XFamily Nurse Practitioner
10364SA2200XAdult Health Clinical Nurse Specialist
11364SP0808XPsychiatric/Mental Health Clinical Nurse Specialist
12364SP0809XAdult Psychiatric/Mental Health Clinical Nurse Specialist
13364SP0813XGeropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
142084N0400XNeurology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053360677
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDOP BEHAVIORAL HEALTH ASSOCIATES PC
Provider Business Mailing Address
First Line : 55 HATCHETTS HILL RD
Second Line :
City : OLD LYME
State : CT
Zip : 06371-1534
Country : US
Telephone Number : 800-370-3651
Fax Number : 877-515-7147
Provider Business Practice Location Address
First Line : 55 HATCHETTS HILL RD
Second Line :
City : OLD LYME
State : CT
Zip : 06371-1534
Country : US
Telephone Number : 800-370-3651
Fax Number : 877-515-7147
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : DONNA DOOLEY
Credential :
Telephone Number : 800-370-3651
Provider Enumeration Date : 05/09/2006
Last Update Date : 07/21/2022

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