MEDICARE: NTW BEHAVIORAL HEALTH SERVICES 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	1041C0700X	Clinical Social Worker	008424	CT

General Provider Information

NPI Number	:	1356834618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NTW BEHAVIORAL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	50 JACKSON RD
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3927
Country	:	US
Telephone Number	:	860-878-1116
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 JACKSON RD
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3927
Country	:	US
Telephone Number	:	860-878-1116
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MISS NADINE TENNEISE WILLIAMS
Credential	:	LCSW
Telephone Number	:	860-878-1116

Provider Enumeration Date	:	06/12/2018
Last Update Date	:	06/12/2018

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