Jessica Persad, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Niantic, CT
NPI 1336907641 · NPPES record last updated Mar 11, 2024
Key facts
- NPI
- 1336907641
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 12949 (CT)
- Practice address
- 201 W Main St
Niantic, CT 06357-1014 - Phone
- (860) 334-8755
- NPI assigned
- Mar 11, 2024
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241024000838 | CT | Practitioner - Nurse Practitioner | 8022541473 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12949 | CT | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Natchaug Hospital, Inc. | Current |
Accepting new patients |
Locations
151 Storrs Rd
Mansfield Center, CT 06250
Phone (860) 456-1780
189 Storrs Rd
Mansfield Ctr, CT 06250
Phone (860) 456-1311
1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 12949 | CT | Yes |
Addresses
Primary practice location
201 W Main St
Niantic, CT 06357-1014
Mailing address
47 Laurel Hill Dr
Niantic, CT 06357-1536
Phone (860) 334-8755
Other providers in Niantic, CT
- Lee Oren
- Pape Chiropractic & Wellness Center LLC
- Anthony S. D. Parisi
- Patricia Giannattasio Counseling & Therapy LLC
- Emily Pattavina
- Jonathan Robert Piposar
- Eric Ploof
- Potential CT LLC
- Linda Preato
- Mark Price
All providers in Niantic, CT · Psychiatric/Mental Health Nurse Practitioner in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.