Provider Demographics
NPI:1700210549
Name:NEW LEAF INSTITUTE OF BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:NEW LEAF INSTITUTE OF BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENKELIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GJUSHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-384-9477
Mailing Address - Street 1:1090 ELM ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1849
Mailing Address - Country:US
Mailing Address - Phone:860-384-9477
Mailing Address - Fax:
Practice Address - Street 1:1090 ELM ST
Practice Address - Street 2:SUITE 104
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1849
Practice Address - Country:US
Practice Address - Phone:860-384-9477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CT008058251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty