| Ellington Behavioral Health | |
|
105 West Rd Ellington CT 06029-5700 | |
| (860) 871-5402 | |
| (860) 871-5413 |
| Full Name | Ellington Behavioral Health |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 105 West Rd, Ellington, Connecticut |
| Authorized Official Name and Position | Erum Shahab (OWNER) |
| Authorized Official Contact | 8608715402 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellington Behavioral Health 105 West Rd Ellington CT 06029-4247 Ph: (860) 871-5402 | Ellington Behavioral Health 105 West Rd Ellington CT 06029-5700 Ph: (860) 871-5402 |
| NPI Number | 1871744243 |
|---|---|
| Provider Enumeration Date | 10/03/2008 |
| Last Update Date | 02/24/2015 |
| Medicare PECOS PAC ID | 4183782360 |
|---|---|
| Medicare Enrollment ID | O20081016000105 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871744243 | NPI | - | NPPES |
| Provider Name | Erum Shahab |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669434049 PECOS PAC ID: 8527069194 Enrollment ID: I20070530000179 |
| Provider Name | Kelly Schmidt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1073828117 PECOS PAC ID: 2365637014 Enrollment ID: I20101108001444 |
| Provider Name | Serita Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417203142 PECOS PAC ID: 2062661085 Enrollment ID: I20121009000005 |
| Provider Name | Charles V Lange |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790020840 PECOS PAC ID: 3870870405 Enrollment ID: I20170508001369 |
| Provider Name | Cassandra Shepard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740718618 PECOS PAC ID: 9436422508 Enrollment ID: I20170912001926 |
| Provider Name | William A Abrokwa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205346335 PECOS PAC ID: 0749547651 Enrollment ID: I20171201000693 |
| Provider Name | Radmila M Meyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174090617 PECOS PAC ID: 3274872569 Enrollment ID: I20190304002701 |
| Provider Name | Christian Edward Klein |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730490061 PECOS PAC ID: 5597186585 Enrollment ID: I20200529000981 |
| Provider Name | Mojdeh Heidari |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306300397 PECOS PAC ID: 7719363514 Enrollment ID: I20221003000236 |
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