| Apple Valley Behavioral Health Llc | |
|
960 S Main St Plantsville CT 06479-1645 | |
| (203) 631-5661 | |
| Not Available |
| Full Name | Apple Valley Behavioral Health Llc |
|---|---|
| Speciality | Counselor |
| Location | 960 S Main St, Plantsville, Connecticut |
| Authorized Official Name and Position | Joanne Etter (OWNER) |
| Authorized Official Contact | 2036315661 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Apple Valley Behavioral Health Llc 960 S Main St Plantsville CT 06479-1645 Ph: (203) 631-5661 | Apple Valley Behavioral Health Llc 960 S Main St Plantsville CT 06479-1645 Ph: (203) 631-5661 |
| NPI Number | 1568843456 |
|---|---|
| Provider Enumeration Date | 06/16/2015 |
| Last Update Date | 06/16/2015 |
| Medicare PECOS PAC ID | 5991122756 |
|---|---|
| Medicare Enrollment ID | O20200826000298 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568843456 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 002491 (Connecticut) | Primary |
| Provider Name | Brandy Michelle Kennerson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912545203 PECOS PAC ID: 7214362631 Enrollment ID: I20200113002220 |
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