| Gilead Community Services, Inc. | |
|
230 Main Street Ext Middletown CT 06457-4470 | |
| (860) 343-5300 | |
| (830) 343-5306 |
| Full Name | Gilead Community Services, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 230 Main Street Ext, Middletown, Connecticut |
| Authorized Official Name and Position | Daniel E Osborne (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8603435300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gilead Community Services, Inc. 222 Main Street Ext P.o. Box 1000 Middletown CT 06457-4406 Ph: (860) 343-5300 | Gilead Community Services, Inc. 230 Main Street Ext Middletown CT 06457-4470 Ph: (860) 343-5300 |
| NPI Number | 1518948025 |
|---|---|
| Provider Enumeration Date | 11/10/2005 |
| Last Update Date | 06/27/2019 |
| Medicare PECOS PAC ID | 0244289643 |
|---|---|
| Medicare Enrollment ID | O20050112000765 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518948025 | NPI | - | NPPES |
| 004140505 | Medicaid | CT | |
| C01863 | Other | CT | PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 0543 (Connecticut) | Primary |
| Provider Name | Susan E Grey |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1952336893 PECOS PAC ID: 7911946173 Enrollment ID: I20050427000554 |
| Provider Name | Stuart M Forman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437193638 PECOS PAC ID: 6103924717 Enrollment ID: I20070605000629 |
| Provider Name | James Gusfa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437287745 PECOS PAC ID: 9739371196 Enrollment ID: I20101005000166 |
| Provider Name | Christopher J Kochis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609971696 PECOS PAC ID: 4880878750 Enrollment ID: I20110419000011 |
| Provider Name | Dawn E Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295121135 PECOS PAC ID: 1850695123 Enrollment ID: I20160205002076 |
| Provider Name | Martha Jean Stewart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598132581 PECOS PAC ID: 6204146376 Enrollment ID: I20160520000477 |
| Provider Name | Mary Silka |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811351117 PECOS PAC ID: 0345536660 Enrollment ID: I20160912002130 |
| Provider Name | Mona C Daye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619140316 PECOS PAC ID: 3072640085 Enrollment ID: I20161213001304 |
| Provider Name | Laura E Gabriel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003388919 PECOS PAC ID: 5092053975 Enrollment ID: I20190219002866 |
| Provider Name | Nadia S Redway |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356734875 PECOS PAC ID: 1355681123 Enrollment ID: I20190314002373 |
| Provider Name | Hye Sil Adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871141267 PECOS PAC ID: 0648699413 Enrollment ID: I20200928002229 |
| Provider Name | Scott Enright |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922608611 PECOS PAC ID: 0446635106 Enrollment ID: I20220915002201 |
| Provider Name | Joanne Tan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538294475 PECOS PAC ID: 9436294758 Enrollment ID: I20221205002641 |
| Provider Name | Laurel J Guertin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346388675 PECOS PAC ID: 3173627452 Enrollment ID: I20230323002016 |
| Provider Name | Michael Anthony Black |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437703873 PECOS PAC ID: 2668824533 Enrollment ID: I20240226002506 |
| Provider Name | Cynthia J Lee |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699729319 PECOS PAC ID: 0840642484 Enrollment ID: I20240305001851 |
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