Provider Demographics
NPI:1003071275
Name:WANDEMBERGH MENTAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:WANDEMBERGH MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-643-5387
Mailing Address - Street 1:206 WELLS ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6152
Mailing Address - Country:US
Mailing Address - Phone:860-643-5387
Mailing Address - Fax:860-643-5387
Practice Address - Street 1:206 WELLS ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6152
Practice Address - Country:US
Practice Address - Phone:860-643-5387
Practice Address - Fax:860-643-5387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-27
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002846103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty