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NPI Code Detail

MEDICARE: OPTUM BEHAVIORAL CARE OF CONNECTICUT, P.C.

MEDICARE: OPTUM BEHAVIORAL CARE OF CONNECTICUT, P.C.
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
1103TC1900XCounseling Psychologist

General Provider Information

NPI Number : 1811778988
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPTUM BEHAVIORAL CARE OF CONNECTICUT, P.C.
Provider Business Mailing Address
First Line : 67 BURNSIDE AVE
Second Line :
City : EAST HARTFORD
State : CT
Zip : 06108-3408
Country : US
Telephone Number : 952-246-4564
Fax Number :
Provider Business Practice Location Address
First Line : 1420 WALNUT ST STE 802
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19102-4008
Country : US
Telephone Number : 610-544-2110
Fax Number :
Authorized Official
Title or Position : CEO
Name : AMANDA BRONSON
Credential :
Telephone Number : 704-506-6267
Provider Enumeration Date : 10/13/2023
Last Update Date : 12/07/2023

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