Wildwood Behavioral Health, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

WILDWOOD BEHAVIORAL HEALTH, LLC

Practice address

1250 Durham Rd Ste F
Madison, CT 06443-8015

Phone

(203) 421-6372

Fax

(203) 421-2090

NPI assigned

Jul 26, 2021

Last updated

Jul 29, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Matthew Gallup

Title

Director of Operations

Phone

(617) 905-1269

Specialties & licenses 3

Addresses

Electronic endpoints 1

Locations

Practitioners 1

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.

• Kevin Murray, DSW, LCSW, LADC

  • Addiction (Substance Use Disorder) Counselor
  • Guilford, CT
  • NPI 1972079077
  NPD (past)

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

{
    "created_epoch": "1627257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659052800000",
    "number": "1366115552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 DURHAM RD STE F",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064438015",
            "telephone_number": "203-421-6372",
            "fax_number": "203-421-2090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 DURHAM RD STE F",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064438015",
            "telephone_number": "203-421-6372",
            "fax_number": "203-421-2090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1250 Durham Rd Ste F",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "CT",
            "postal_code": "064438015",
            "country_code": "US",
            "telephone_number": "203-421-6372",
            "fax_number": "203-421-2090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WILDWOOD BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-26",
        "last_updated": "2022-07-29",
        "certification_date": "2022-07-29",
        "status": "A",
        "authorized_official_last_name": "GALLUP",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "617-905-1269"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Alleva",
            "affiliation": "N",
            "endpointDescription": "Behavioral Health Electronic Medical Record",
            "address_1": "1250 Durham Rd Ste F",
            "city": "Madison",
            "state": "CT",
            "country_code": "US",
            "postal_code": "064438015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Watrous Nursing Center Inc. (Watrous Nursing Center)
• Donald Benjamin Weeks
• Alan Michael Weiss, DMD
• Mary Elizabeth Whalen
• Gail Barbara Whitman, M.D.
• Patrice M Wilhelm, APRN
• Elizabeth Wilson, LMFT
• Evan Woodford
• Scott H. Woodford, DMD
• Brandon Wright

• Mental Health Clinic/Center (Including Community Mental Health Center) in Madison, CT
• Providers in Madison, CT by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2022; 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.