Provider Demographics
NPI:1245055383
Name:HOPE BEHAVIORAL WELLNESS LLC
Entity type:Organization
Organization Name:HOPE BEHAVIORAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORRETT
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-221-8068
Mailing Address - Street 1:601 BRICKLAYER RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1771
Mailing Address - Country:US
Mailing Address - Phone:860-221-8068
Mailing Address - Fax:
Practice Address - Street 1:378 WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-4551
Practice Address - Country:US
Practice Address - Phone:860-221-8068
Practice Address - Fax:860-683-8996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty