Provider Demographics
NPI:1407264351
Name:PSYCHIATRIC HEALTH ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PSYCHIATRIC HEALTH ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOORIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, APRN-BC
Authorized Official - Phone:203-693-2636
Mailing Address - Street 1:75 NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4854
Mailing Address - Country:US
Mailing Address - Phone:203-693-2636
Mailing Address - Fax:203-874-2965
Practice Address - Street 1:75 NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4854
Practice Address - Country:US
Practice Address - Phone:203-693-2636
Practice Address - Fax:203-874-2965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3777363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT8040766Medicaid
CT8040766Medicaid