MEDICARE: PAUL BATTLES 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1548913742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL BATTLES LLC

Provider Business Mailing Address
First Line	:	26 STONE ST
Second Line	:
City	:	BRANFORD
State	:	CT
Zip	:	06405-6242
Country	:	US
Telephone Number	:	203-668-8660
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 DURHAM RD STE 26
Second Line	:
City	:	MADISON
State	:	CT
Zip	:	06443-2664
Country	:	US
Telephone Number	:	203-208-6038
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PAUL BATTLES
Credential	:	LPC
Telephone Number	:	203-668-8660

Provider Enumeration Date	:	01/28/2022
Last Update Date	:	01/28/2022

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