Provider Demographics
NPI:1538812383
Name:SANDY HOOK BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:SANDY HOOK BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUJANAC
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-304-1981
Mailing Address - Street 1:107 CHURCH HILL RD BLDG ASE2A
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1194
Mailing Address - Country:US
Mailing Address - Phone:203-304-1981
Mailing Address - Fax:203-304-1891
Practice Address - Street 1:107 CHURCH HILL RD BLDG ASE2A
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1194
Practice Address - Country:US
Practice Address - Phone:203-304-1981
Practice Address - Fax:203-304-1891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty