Provider Demographics
NPI:1740587526
Name:PSYCHIATRIC TREATMENT & RESOURCE CENTER INC.
Entity Type:Organization
Organization Name:PSYCHIATRIC TREATMENT & RESOURCE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN2035565225
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:GRISGRABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-556-5225
Mailing Address - Street 1:310 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-2919
Mailing Address - Country:US
Mailing Address - Phone:203-672-5956
Mailing Address - Fax:203-404-7126
Practice Address - Street 1:647 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-2032
Practice Address - Country:US
Practice Address - Phone:203-672-5956
Practice Address - Fax:203-404-7126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001868261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT364SP0808XOtherCLINICAL SPECIALIST PSYCH MENTAL HEALTH