| Healthdrive Behavioral Health Services, Pllc | |
|
101 Centerpoint Dr Ste 215 Middletown CT 06457-7568 | |
| (888) 964-6681 | |
| (888) 662-0859 |
| Full Name | Healthdrive Behavioral Health Services, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 101 Centerpoint Dr Ste 215, Middletown, Connecticut |
| Authorized Official Name and Position | Ricardo A Mujica (PRESIDENT) |
| Authorized Official Contact | 6179646681 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthdrive Behavioral Health Services, Pllc 100 Crossing Blvd Suite 300 Framingham MA 01702-5555 Ph: (617) 964-6681 | Healthdrive Behavioral Health Services, Pllc 101 Centerpoint Dr Ste 215 Middletown CT 06457-7568 Ph: (888) 964-6681 |
| NPI Number | 1760909279 |
|---|---|
| Provider Enumeration Date | 08/25/2017 |
| Last Update Date | 09/01/2021 |
| Certification Date | 09/01/2021 |
| Medicare PECOS PAC ID | 8729345822 |
|---|---|
| Medicare Enrollment ID | O20171128001313 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760909279 | NPI | - | NPPES |
| Provider Name | Tamara Connelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790035012 PECOS PAC ID: 6204087349 Enrollment ID: I20121119000262 |
| Provider Name | Lisa Fargnoli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710302542 PECOS PAC ID: 7618255886 Enrollment ID: I20161024001648 |
| Provider Name | Ricardo Mujica |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1356359152 PECOS PAC ID: 9335117423 Enrollment ID: I20191022001506 |
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