MEDICARE: SELECT BEHAVIORAL HEALTH, 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	000249	CT
2	103TC0700X	Clinical Psychologist	000536	CT
3	1041C0700X	Clinical Social Worker	000128	CT
4	1041C0700X	Clinical Social Worker	002132	CT
5	1041C0700X	Clinical Social Worker	001361	CT
6	1041C0700X	Clinical Social Worker	004832	CT
7	1041C0700X	Clinical Social Worker	005699	CT
8	1041C0700X	Clinical Social Worker	002573	CT
9	1041C0700X	Clinical Social Worker	000230	CT
10	1041C0700X	Clinical Social Worker	002145	CT
11	1041C0700X	Clinical Social Worker	005667	CT
12	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	001534	CT
13	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	001589	CT
14	2084P0800X	Psychiatry Physician	023549	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	170415	OTHER		MHN GROUP ID

General Provider Information

NPI Number	:	1609941731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELECT BEHAVIORAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	72 NEW LONDON TPKE
Second Line	:
City	:	NORWICH
State	:	CT
Zip	:	06360-2614
Country	:	US
Telephone Number	:	860-886-8122
Fax Number	:	860-889-7255

Provider Business Practice Location Address
First Line	:	72 NEW LONDON TPKE
Second Line	:
City	:	NORWICH
State	:	CT
Zip	:	06360-2614
Country	:	US
Telephone Number	:	860-886-8122
Fax Number	:	860-889-7255

Authorized Official
Title or Position	:	PSYCHIATRIST
Name	:	DR. ALNOOR RAMJI
Credential	:	MD
Telephone Number	:	860-886-8122

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	10/15/2011

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Directions to “SELECT BEHAVIORAL HEALTH, LLC ” Practice Location

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