Provider Demographics
NPI:1043666480
Name:CENTRAL CONNECTICUT BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:CENTRAL CONNECTICUT BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:COMSHAW
Authorized Official - Suffix:II
Authorized Official - Credentials:PHD APRN
Authorized Official - Phone:860-736-4139
Mailing Address - Street 1:238 CONGDON ST E
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2063
Mailing Address - Country:US
Mailing Address - Phone:860-736-4139
Mailing Address - Fax:
Practice Address - Street 1:2275 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-2329
Practice Address - Country:US
Practice Address - Phone:860-736-4139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0400632084P0800X
CT0001702363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty