Provider Demographics
NPI:1750973152
Name:MAGNOLIA BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:MAGNOLIA BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSIKA
Authorized Official - Middle Name:DUCHARME
Authorized Official - Last Name:BRASSEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP
Authorized Official - Phone:203-903-9797
Mailing Address - Street 1:50 BREWERY ST UNIT 9138
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5954
Mailing Address - Country:US
Mailing Address - Phone:203-903-9797
Mailing Address - Fax:844-440-2333
Practice Address - Street 1:762 BOSTON POST RD FL 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3047
Practice Address - Country:US
Practice Address - Phone:203-903-9728
Practice Address - Fax:844-440-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-07
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty