Holistic Behavioral Health of Connecticut LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

HOLISTIC BEHAVIORAL HEALTH OF CONNECTICUT LLC

Practice address

116 Cottage Grove Rd Ste 110
Bloomfield, CT 06002-3200

Phone

(860) 904-5433

Fax

(860) 904-5456

NPI assigned

Dec 28, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Okechukwu C Chidiadi, APRNNPI 1457922692

Title

Owner

Phone

(608) 695-0308

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Okechukwu C Chidiadi, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • South Windsor, CT
  • NPI 1457922692

  CT, Psychiatric/Mental Health

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1640649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640649600000",
    "number": "1043970387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 COTTAGE GROVE RD STE 110",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060023200",
            "telephone_number": "860-869-5030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 COTTAGE GROVE RD STE 110",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060023200",
            "telephone_number": "860-904-5433",
            "fax_number": "860-904-5456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLISTIC BEHAVIORAL HEALTH OF CONNECTICUT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-28",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A",
        "authorized_official_last_name": "CHIDIADI",
        "authorized_official_first_name": "OKECHUKWU",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "608-695-0308",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.