NPIMap

Organization Active NPI

Connecticut Psychiatric & Wellness Center

  • Community/Behavioral Health Agency
  • Woodbridge, CT
National Provider Identifier
1174902084
Registry record updated May 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
2422 Issued in CT
Legal business name
CONNECTICUT PSYCHIATRIC & WELLNESS CENTER
Practice address
1 Bradley Rd
404
Woodbridge, CT 06525-2285
Phone
(203) 298-9005
NPI assigned
May 26, 2015
Last updated
May 26, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2015

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

Authorized official

Name
David AversaNPI 1669655726
Title
Medical Director
Phone
(203) 298-9005

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 2422 CT Primary

Addresses

Primary practice location

1 Bradley Rd
404
Woodbridge, CT 06525-2285

Mailing address

1 Bradley Rd
Suite 404
Woodbridge, CT 06525-2285

National Provider Directory

National Provider Directory
Tax ID family
Connecticut Psychiatric Wellness Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1432598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432598400000",
    "number": "1174902084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BRADLEY RD",
            "address_2": "SUITE 404",
            "city": "WOODBRIDGE",
            "state": "CT",
            "postal_code": "065252285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BRADLEY RD",
            "address_2": "404",
            "city": "WOODBRIDGE",
            "state": "CT",
            "postal_code": "065252285",
            "telephone_number": "203-298-9005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT PSYCHIATRIC & WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-26",
        "last_updated": "2015-05-26",
        "status": "A",
        "authorized_official_last_name": "AVERSA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "203-298-9005"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CT",
            "license": "2422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2015; 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.