Provider Demographics
NPI:1376997007
Name:YOUSIF, FIRAS TOMY (MD)
Entity Type:Individual
Prefix:
First Name:FIRAS
Middle Name:TOMY
Last Name:YOUSIF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 COLUMBUS AVENUE
Mailing Address - Street 2:CREDENTIALING SPECIALIST
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1233
Mailing Address - Country:US
Mailing Address - Phone:203-503-3000
Mailing Address - Fax:
Practice Address - Street 1:410 CAMPBELL AVE
Practice Address - Street 2:WEST HAVEN BEHAVIORAL HEALTH
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516
Practice Address - Country:US
Practice Address - Phone:203-503-3409
Practice Address - Fax:203-503-3414
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2021-10-21
Deactivation Date:2016-12-06
Deactivation Code:
Reactivation Date:2017-01-23
Provider Licenses
StateLicense IDTaxonomies
CT674402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008102734Medicaid