Provider Demographics
NPI:1659808699
Name:PSY-VISIONS OF CONNECTICUT, LLC
Entity Type:Organization
Organization Name:PSY-VISIONS OF CONNECTICUT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:STRACKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS, MPH
Authorized Official - Phone:706-718-8056
Mailing Address - Street 1:370 WEEKEEPEEMEE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-1621
Mailing Address - Country:US
Mailing Address - Phone:706-718-8056
Mailing Address - Fax:203-405-1745
Practice Address - Street 1:88 MAIN ST S STE B201
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2276
Practice Address - Country:US
Practice Address - Phone:203-405-1745
Practice Address - Fax:203-405-1745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT546022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty