Provider Demographics
NPI:1245016005
Name:CONNECTICUT CENTER FOR PSYCHIATRIC WELLNESS LLC
Entity type:Organization
Organization Name:CONNECTICUT CENTER FOR PSYCHIATRIC WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:VOIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-565-5104
Mailing Address - Street 1:92 MACINTOSH WAY
Mailing Address - Street 2:C/O ERIC W. VOIDE
Mailing Address - City:SOUTHINGTON,
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2055
Mailing Address - Country:US
Mailing Address - Phone:203-565-5104
Mailing Address - Fax:860-826-4762
Practice Address - Street 1:136 SHERMAN AVENUE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5238
Practice Address - Country:US
Practice Address - Phone:203-565-5104
Practice Address - Fax:860-826-4762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty