Provider Demographics
NPI:1093582066
Name:ADVANCED MENTAL HEALTH ASSOCIATES PLLC
Entity Type:Organization
Organization Name:ADVANCED MENTAL HEALTH ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-632-0617
Mailing Address - Street 1:80 OLD RIDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-3012
Mailing Address - Country:US
Mailing Address - Phone:203-632-0617
Mailing Address - Fax:203-312-1931
Practice Address - Street 1:80 OLD RIDGEFIELD RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-3012
Practice Address - Country:US
Practice Address - Phone:203-632-0617
Practice Address - Fax:203-312-1931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health