Provider Demographics
NPI:1497402317
Name:INTEGRATED MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:INTEGRATED MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO,APRN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:PASACRETA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PHD
Authorized Official - Phone:203-270-0080
Mailing Address - Street 1:4 ABBEY LN
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-2784
Mailing Address - Country:US
Mailing Address - Phone:203-270-0080
Mailing Address - Fax:203-304-1191
Practice Address - Street 1:4 ABBEY LN
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-2784
Practice Address - Country:US
Practice Address - Phone:203-270-0080
Practice Address - Fax:203-304-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004253728Medicaid
CTQ59438OtherMEDICARE UPIN