Haruna Asafotei, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Bridgeport, CT
NPI 1669080933 · NPPES record last updated Mar 6, 2023
Key facts
- NPI
- 1669080933
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 0024179871 (VA)
- Practice address
- 267 Grant St
Bridgeport, CT 06610-2805 - Phone
- (203) 384-4626
- NPI assigned
- Jul 22, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA, 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 |
|---|---|---|---|---|
| I20210204000069 | VA | Practitioner - Nurse Practitioner | 9032523964 | |
| I20221206000435 | CT | Practitioner - Nurse Practitioner | 9032523964 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science - Nursing
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11163 | CT | MD | Clinical Social Worker |
| 011163 | CT | MD | Psychiatric/Mental Health Nurse Practitioner |
| 2371434 | MA | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Natchaug Hospital, Inc. | Current |
Accepting new patients | |
| Northeast Medical Group, Inc. | Current |
Accepting new patients | |
| Holyoke Capital JV, LLC | Past | Accepting new patients |
Locations
267 Grant St
Bridgeport, CT 06610
Phone (203) 384-3170
189 Storrs Rd
Mansfield Ctr, CT 06250
Phone (860) 456-1311
95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388
99 Hawley Ln
Fl 3
Stratford, CT 06614
Phone (203) 502-4650
Interoperability endpoints
- haruna.asafotei@hca6.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 2371434 | MA | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 011163 | CT | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 0024179871 | VA | Yes |
Addresses
Primary practice location
267 Grant St
Bridgeport, CT 06610-2805
Mailing address
2000 Health Park Dr FL HP2
Brentwood, TN 37027-4525
Phone (615) 373-7600
Other practice location 1
2960 Sleepy Hollow Rd
Falls Church, VA 22044-2030
Phone (703) 538-2871 ext. 6120
Other practice location 2
1 ARH Lane
5th Floor Transitional Unit
Low Moor, VA 24457
Phone (540) 862-2021
Other providers in Bridgeport, CT
- Andre Aguilucho Arnaldo
- Kayla Arnone
- Seppo Aro
- Alivia Aron
- David C Arpie
- Shawntae Asberry
- Ascension Mental Health & Wellness Center, LLC
- Holly S. Ashby
- Patience Ashong
- Assel Livery Service LLC
All providers in Bridgeport, 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 6, 2023. 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.