Provider Demographics
NPI:1134407174
Name:COMPASSIONATE PSYCHIATRIC CARE, LLC
Entity type:Organization
Organization Name:COMPASSIONATE PSYCHIATRIC CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN-BC
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:E
Authorized Official - Last Name:DURIVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:203-421-6156
Mailing Address - Street 1:60 BOSTON POST RD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2157
Mailing Address - Country:US
Mailing Address - Phone:203-421-6156
Mailing Address - Fax:203-421-6157
Practice Address - Street 1:60 BOSTON POST RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2157
Practice Address - Country:US
Practice Address - Phone:203-421-6156
Practice Address - Fax:203-421-6157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004454364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty