Phoenix Professional Services

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

002311 Issued in CT

Legal business name

PHOENIX PROFESSIONAL SERVICES

Practice address

29 Connecticut Blvd
East Hartford, CT 06108-3008

Phone

(860) 778-1257

NPI assigned

Apr 4, 2014

Organization subpart

No

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

Authorized official

Name

Ms. Tamar Draughn, LPC

Title

Clinical Director

Phone

(860) 680-9440

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1396569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403136000000",
    "number": "1801214986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 CONNECTICUT BLVD",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061083008",
            "telephone_number": "860-778-1257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 CONNECTICUT BLVD",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061083008",
            "telephone_number": "860-778-1257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX PROFESSIONAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-04",
        "last_updated": "2014-06-19",
        "status": "A",
        "authorized_official_last_name": "DRAUGHN",
        "authorized_official_first_name": "TAMAR",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "860-680-9440",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CT",
            "license": "002311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008046849",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marianne Persaud
• Peter T. Krenicky MD PC
• Christal V Petrone, RN
• Towanna Phillip, LCSW
• Sky Phillips
• Phoenix Psychiatry LLC
• Rebecca Blake Pieper, APRN FNP-BC
• Colae Pinnock
• Jayann L Pinto-Samuda, LCSW
• Nicholas A Pisanelli, PT, DPT, ATC

• Community/Behavioral Health Agency in East Hartford, CT
• Providers in East Hartford, CT by specialty
• Community/Behavioral Health Agency in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2014; 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.