Provider Demographics
NPI:1508546524
Name:GLASTONBURY PSYCHIATRIC CARE LLC
Entity Type:Organization
Organization Name:GLASTONBURY PSYCHIATRIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH JANE
Authorized Official - Middle Name:DE ASIS
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-660-4384
Mailing Address - Street 1:90 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3931
Mailing Address - Country:US
Mailing Address - Phone:201-660-4384
Mailing Address - Fax:
Practice Address - Street 1:200 OAK ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4805
Practice Address - Country:US
Practice Address - Phone:959-867-9880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty