Provider Demographics
NPI:1922464783
Name:SERENITY BEHAVIORAL HEALTH AND INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:SERENITY BEHAVIORAL HEALTH AND INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WRATCHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-326-5597
Mailing Address - Street 1:8 HEARTWELL DR
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-2873
Mailing Address - Country:US
Mailing Address - Phone:860-326-5597
Mailing Address - Fax:
Practice Address - Street 1:8 HEARTWELL DR
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-2873
Practice Address - Country:US
Practice Address - Phone:860-326-5597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty