Phoenix Psychiatry LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PHOENIX PSYCHIATRY LLC

Practice address

254 Burnside Ave Ste 4
East Hartford, CT 06108-2367

Phone

(860) 780-4313

NPI assigned

Aug 16, 2022

Organization subpart

No

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

Authorized official

Name

Anthea MendezNPI 1912194796

Title

Owner

Phone

(860) 780-4313

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT, MA2 enrollments

Enrollment records 2

Locations

Practitioners 1

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

• Anthea Mendez, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Wethersfield, CT
  • NPI 1912194796

  Acute Care, MA

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1660608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660608000000",
    "number": "1396463303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "254 BURNSIDE AVE STE 4",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061082367",
            "telephone_number": "860-780-4313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "254 BURNSIDE AVE STE 4",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061082367",
            "telephone_number": "860-780-4313"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "250 Pomeroy Ave",
            "address_purpose": "LOCATION",
            "city": "Meriden",
            "state": "CT",
            "postal_code": "064508316",
            "country_code": "US",
            "telephone_number": "860-780-4313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PHOENIX PSYCHIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-16",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A",
        "authorized_official_last_name": "MENDEZ",
        "authorized_official_first_name": "ANTHEA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-780-4313"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter T. Krenicky MD PC
• Christal V Petrone, RN
• Towanna Phillip, LCSW
• Sky Phillips
• Phoenix Professional Services
• Rebecca Blake Pieper, APRN FNP-BC
• Colae Pinnock
• Jayann L Pinto-Samuda, LCSW
• Nicholas A Pisanelli, PT, DPT, ATC
• Gerald G Piserchia, M.D.

• Clinic/Center in East Hartford, CT
• Providers in East Hartford, CT by specialty
• Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; 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.