| Masonicare Behavioral Health, Llc | |
|
67 Masonic Ave 1st Floor Wallingford CT 06492-3095 | |
| (203) 265-5720 | |
| (203) 679-5623 |
| Full Name | Masonicare Behavioral Health, Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Geriatric Psychiatry |
| Location | 67 Masonic Ave, Wallingford, Connecticut |
| Authorized Official Name and Position | John Tibbetts (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 2032655720 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Masonicare Behavioral Health, Llc 67 Masonic Ave 1st Floor Wallingford CT 06492-3095 Ph: (203) 265-5720 | Masonicare Behavioral Health, Llc 67 Masonic Ave 1st Floor Wallingford CT 06492-3095 Ph: (203) 265-5720 |
| NPI Number | 1992781488 |
|---|---|
| Provider Enumeration Date | 12/16/2005 |
| Last Update Date | 06/06/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992781488 | NPI | - | NPPES |
| 004183050 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0805X | Psychiatry & Neurology - Geriatric Psychiatry | (* (Not Available)) | Primary |
N.c.k., Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2 Bull Ave, 7, Wallingford, CT 06492 Phone: 203-809-2455 | |
Jennifer Smith, Lcsw Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 65 S Colony St, Wallingford, CT 06492 Phone: 860-581-0215 | |
Licenced Clinical Social Worker Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 86 Mapleview Rd, Wallingford, CT 06492 Phone: 203-996-6732 | |
Amy Cave, Lmft, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 108 Mohawk Dr, Wallingford, CT 06492 Phone: 860-941-6159 | |
Compassion Coherence Llp Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 124 Mapleview Rd, Wallingford, CT 06492 Phone: 203-589-4826 Fax: 203-349-9216 | |
Jacqueline Mcnamee, Lmft Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 40 Deer Run Rd, Wallingford, CT 06492 Phone: 203-815-9214 | |
Visiting Nurse Association Of Wallingford, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 135 N Plains Industrial Rd, Wallingford, CT 06492 Phone: 203-269-1475 Fax: 203-265-5357 |