Provider Demographics
NPI:1003688037
Name:OPTUM BEHAVIORAL CARE OF CONNECTICUT, P.C.
Entity Type:Organization
Organization Name:OPTUM BEHAVIORAL CARE OF CONNECTICUT, P.C.
Other - Org Name:TIDES OF MIND COUNSELING OF RHODE ISLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-506-6267
Mailing Address - Street 1:67 BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3408
Mailing Address - Country:US
Mailing Address - Phone:952-246-4564
Mailing Address - Fax:
Practice Address - Street 1:245 WATERMAN ST STE 200
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5215
Practice Address - Country:US
Practice Address - Phone:401-369-8192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty