Provider Demographics
NPI:1518003680
Name:NORWICH PSYCHIATRIC CENTER
Entity Type:Organization
Organization Name:NORWICH PSYCHIATRIC CENTER
Other - Org Name:WALID A. JAZIRI, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WALID
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAZIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-889-3052
Mailing Address - Street 1:108 NEW LONDON TPKE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2645
Mailing Address - Country:US
Mailing Address - Phone:860-889-3052
Mailing Address - Fax:860-889-0926
Practice Address - Street 1:108 NEW LONDON TPKE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2645
Practice Address - Country:US
Practice Address - Phone:860-889-3052
Practice Address - Fax:860-889-0926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTIN