Provider Demographics
NPI:1861672875
Name:PSYCHIATRIC WELLNES CENTER, LLC
Entity Type:Organization
Organization Name:PSYCHIATRIC WELLNES CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-628-9121
Mailing Address - Street 1:51 N MAIN ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2537
Mailing Address - Country:US
Mailing Address - Phone:860-628-9121
Mailing Address - Fax:860-276-8670
Practice Address - Street 1:51 N MAIN ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2537
Practice Address - Country:US
Practice Address - Phone:860-628-9121
Practice Address - Fax:860-276-8670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0261622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03003Medicare PIN