Image of Light Mental Health Services, LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

IMAGE OF LIGHT MENTAL HEALTH SERVICES, LLC

Practice address

45 S Main St Ste 70
West Hartford, CT 06107

Phone

(860) 299-6677

NPI assigned

Apr 3, 2018

Organization subpart

No

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

Authorized official

Name

Miriam Haynes, APRN

Title

Owner

Phone

(860) 299-6677

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1522713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531094400000",
    "number": "1124524798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 BURNWOOD DR",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060022235",
            "telephone_number": "860-299-6677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 S MAIN ST STE 70",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "06107",
            "telephone_number": "860-299-6677"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Barnard Ln Ste 309",
            "address_purpose": "LOCATION",
            "city": "Bloomfield",
            "state": "CT",
            "postal_code": "060022495",
            "country_code": "US",
            "telephone_number": "203-299-6677",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3 Barnard Ln Ste 309",
            "address_purpose": "LOCATION",
            "city": "Bloomfield",
            "state": "CT",
            "postal_code": "060022495",
            "country_code": "US",
            "telephone_number": "203-299-6677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IMAGE OF LIGHT MENTAL HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-03",
        "last_updated": "2018-07-09",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "MIRIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-299-6677",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in West Hartford, CT
• Providers in West Hartford, CT by specialty
• Psychiatric/Mental Health Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.