Provider Demographics
NPI:1720239890
Name:FAMILY PSYCHIATRIC SERVICES
Entity Type:Organization
Organization Name:FAMILY PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARANDO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-747-5282
Mailing Address - Street 1:816 ASPEN GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-5310
Mailing Address - Country:US
Mailing Address - Phone:203-747-5282
Mailing Address - Fax:203-248-3339
Practice Address - Street 1:2553 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3021
Practice Address - Country:US
Practice Address - Phone:203-747-5282
Practice Address - Fax:203-248-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003652363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty