Provider Demographics
NPI:1770303018
Name:HEALINGHAVENPSYCHIATRY, LLC
Entity type:Organization
Organization Name:HEALINGHAVENPSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEON
Authorized Official - Middle Name:
Authorized Official - Last Name:MILARDO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:860-994-8673
Mailing Address - Street 1:6 WAY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06455-1086
Mailing Address - Country:US
Mailing Address - Phone:860-894-9059
Mailing Address - Fax:
Practice Address - Street 1:6 WAY RD
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06455-1080
Practice Address - Country:US
Practice Address - Phone:860-894-9059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty