Provider Demographics
NPI:1942470018
Name:GERIATRIC AND ADULT PSYCHIATRY, LLC
Entity Type:Organization
Organization Name:GERIATRIC AND ADULT PSYCHIATRY, LLC
Other - Org Name:APRN GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGNON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-288-0414
Mailing Address - Street 1:60 WASHINGTON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3271
Mailing Address - Country:US
Mailing Address - Phone:203-288-0414
Mailing Address - Fax:203-288-3655
Practice Address - Street 1:60 WASHINGTON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3271
Practice Address - Country:US
Practice Address - Phone:203-288-0414
Practice Address - Fax:203-288-3655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GERIATRIC AND ADULT PSYCHIATRY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000894101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty