Provider Demographics
NPI:1528326808
Name:CONNECTICUT PSYCHIATRIC & WELLNESS CENTER
Entity type:Organization
Organization Name:CONNECTICUT PSYCHIATRIC & WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ACAMPORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-298-9005
Mailing Address - Street 1:1 BRADLEY RD STE 404
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2235
Mailing Address - Country:US
Mailing Address - Phone:203-298-9005
Mailing Address - Fax:203-535-0023
Practice Address - Street 1:1 BRADLEY RD
Practice Address - Street 2:SUITE 905
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2285
Practice Address - Country:US
Practice Address - Phone:203-298-9005
Practice Address - Fax:203-298-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CT045572261QM0801X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)