MEDICARE: HOPE BEHAVIORAL WELLNESS LLC

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1245055383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE BEHAVIORAL WELLNESS LLC

Provider Business Mailing Address
First Line	:	601 BRICKLAYER RD
Second Line	:
City	:	WINDSOR
State	:	CT
Zip	:	06095-1771
Country	:	US
Telephone Number	:	860-221-8068
Fax Number	:

Provider Business Practice Location Address
First Line	:	378 WINDSOR AVE
Second Line	:
City	:	WINDSOR
State	:	CT
Zip	:	06095-4551
Country	:	US
Telephone Number	:	860-221-8068
Fax Number	:	860-683-8996

Authorized Official
Title or Position	:	PMHNP
Name	:	MRS. DORRETT YVETTE BLACK
Credential	:	APRN
Telephone Number	:	860-221-8068

Provider Enumeration Date	:	11/21/2024
Last Update Date	:	12/31/2024

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