Provider Demographics
NPI:1801204086
Name:HEART & SOUL PSYCHIATRY
Entity Type:Organization
Organization Name:HEART & SOUL PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHCNS-BC
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRZASNYSKI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-539-4117
Mailing Address - Street 1:85 FELT ROAD
Mailing Address - Street 2:WENTWORTH PARK SUITE 603
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3871
Mailing Address - Country:US
Mailing Address - Phone:860-539-4117
Mailing Address - Fax:860-461-0946
Practice Address - Street 1:85 FELT ROAD
Practice Address - Street 2:SUITE 603
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3871
Practice Address - Country:US
Practice Address - Phone:860-539-4117
Practice Address - Fax:860-461-0829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003734364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008001390Medicaid