Provider Demographics
NPI:1215545090
Name:LIV WELL BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:LIV WELL BEHAVIORAL SERVICES
Other - Org Name:OLIVIA CARTER, APRN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR. PSYCHIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN
Authorized Official - Phone:860-969-4411
Mailing Address - Street 1:213 GLEN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3027
Mailing Address - Country:US
Mailing Address - Phone:860-969-4411
Mailing Address - Fax:
Practice Address - Street 1:55 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1416
Practice Address - Country:US
Practice Address - Phone:860-969-4411
Practice Address - Fax:860-926-3032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008086019Medicaid