| Mansfield Mental Health And Addiction Medicine | |
|
18-e Ledgebrook Drive 18-e Mansfield Ctr CT 06250 | |
| (347) 872-3612 | |
| Not Available |
| Full Name | Mansfield Mental Health And Addiction Medicine |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 18-e Ledgebrook Drive, Mansfield Ctr, Connecticut |
| Authorized Official Name and Position | Gengyun Wen (PSYCHIATRIST) |
| Authorized Official Contact | 8608428826 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mansfield Mental Health And Addiction Medicine 18e Ledgebrook Dr Mansfield Center CT 06250-1693 Ph: (860) 942-8826 | Mansfield Mental Health And Addiction Medicine 18-e Ledgebrook Drive 18-e Mansfield Ctr CT 06250 Ph: (347) 872-3612 |
| NPI Number | 1366958480 |
|---|---|
| Provider Enumeration Date | 12/27/2017 |
| Last Update Date | 01/27/2021 |
| Certification Date | 01/27/2021 |
| Medicare PECOS PAC ID | 6305259243 |
|---|---|
| Medicare Enrollment ID | O20210113002113 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366958480 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | (* (Not Available)) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 54266 (Connecticut) | Primary |
| Provider Name | Gengyun Wen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215367081 PECOS PAC ID: 8224318365 Enrollment ID: I20161207002573 |
| Provider Name | Thomas Ranallo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609263938 PECOS PAC ID: 6800221813 Enrollment ID: I20200122001514 |