Ketamine Center LLC

Primary specialty

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

Legal business name

KETAMINE CENTER LLC

Doing business as

Ketamine Center of Connecticut

Practice address

232 Boston Post Rd Ste 13
Milford, CT 06460-3158

Phone

(203) 701-6388

Fax

(203) 306-3134

NPI assigned

Sep 19, 2023

Organization subpart

No

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

Authorized official

Name

Al Gene Ejusa Ang

Title

Office Manager

Phone

(860) 552-7592

Specialties & licenses 1

Addresses

Other names 1

• Ketamine Center of Connecticut Doing business as

Locations

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

{
    "created_epoch": "1695081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701302400000",
    "number": "1720866916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 BOSTON POST RD STE 13",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064603158",
            "telephone_number": "203-701-6388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 BOSTON POST RD STE 13",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064603158",
            "telephone_number": "203-701-6388",
            "fax_number": "203-306-3134"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1720 Post Rd E Ste 211",
            "address_purpose": "LOCATION",
            "city": "Westport",
            "state": "CT",
            "postal_code": "068805643",
            "country_code": "US",
            "telephone_number": "203-701-6388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KETAMINE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-19",
        "last_updated": "2023-11-30",
        "certification_date": "2023-11-30",
        "status": "A",
        "authorized_official_last_name": "ANG",
        "authorized_official_first_name": "AL GENE",
        "authorized_official_middle_name": "EJUSA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "860-552-7592"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ketamine Center of Connecticut",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ketamine Center of Connecticut",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vanessa Elizabeth Kellas
• Kelli Armstrong, PC
• Charles A Kent, DO
• Rita A Kepich
• Lisa Carol Kerin, LCSW
• Aimee Khalifa, LMFT
• Fariha Khan, DO
• Ramsha Khan, PT, DPT
• Danielle Khorsandi, APRN
• Kidsense Occupational Therapy. LLC

• Mental Health Clinic/Center (Including Community Mental Health Center) in Milford, CT
• Providers in Milford, 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 Nov 30, 2023; 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.