Provider Demographics
NPI:1326351412
Name:BEHAVIORAL WELLNESS CLINIC
Entity Type:Organization
Organization Name:BEHAVIORAL WELLNESS CLINIC
Other - Org Name:NEW ENGLAND OCD INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONNICA
Authorized Official - Middle Name:T
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-608-7483
Mailing Address - Street 1:BEHAVIORAL WELLNESS CLINIC
Mailing Address - Street 2:392 MERROW ROAD, SUITE E
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084
Mailing Address - Country:US
Mailing Address - Phone:860-830-7838
Mailing Address - Fax:860-454-0667
Practice Address - Street 1:BEHAVIORAL WELLNESS CLINIC
Practice Address - Street 2:392 MERROW ROAD, SUITE E
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084
Practice Address - Country:US
Practice Address - Phone:860-830-7838
Practice Address - Fax:860-454-0667
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEHAVIORAL WELLNESS CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-19
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty