Provider Demographics
NPI:1407375363
Name:CONNECTICUT GERIATRIC NEUROPSYCHIATRY, LLC
Entity Type:Organization
Organization Name:CONNECTICUT GERIATRIC NEUROPSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRINDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-990-4673
Mailing Address - Street 1:542 HOPMEADOW ST PMB 138
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-5405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:558 HOPMEADOW ST
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2415
Practice Address - Country:US
Practice Address - Phone:860-371-0064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty