Provider Demographics
NPI:1245848670
Name:BEHAVIORAL WELLNESS PARTNERS, LLC
Entity type:Organization
Organization Name:BEHAVIORAL WELLNESS PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUFANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-687-0464
Mailing Address - Street 1:PO BOX 665
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 DAVENPORT FARM LN E
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06903-5141
Practice Address - Country:US
Practice Address - Phone:203-687-0464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1255382396OtherGROUP NPI
CT1245848670OtherGROUP NPI