Provider Demographics
NPI:1750275434
Name:BARDWELL BEHAVIORAL, LLC
Entity type:Organization
Organization Name:BARDWELL BEHAVIORAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:ALIZAH
Authorized Official - Last Name:DOWEYKO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMHC, LCMHC
Authorized Official - Phone:561-504-4373
Mailing Address - Street 1:5 PROGRESS DR
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-1035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:90 APPLETREE LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1072
Practice Address - Country:US
Practice Address - Phone:860-398-9118
Practice Address - Fax:860-740-4485
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARDWELL BEHAVIORAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008111142Medicaid
VT6713839Medicaid