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5 Linsley Street North Haven CT 06473 | |
| (203) 239-5321 | |
| (203) 234-3942 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 5 Linsley Street, North Haven, Connecticut |
| Authorized Official Name and Position | Michael J. Freda (FIRST SELECTMAN) |
| Authorized Official Contact | 2032395321 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
18 Church Street North Haven CT 06473 Ph: (203) 239-5321 | 5 Linsley Street North Haven CT 06473 Ph: (203) 239-5321 |
| NPI Number | 1164513388 |
|---|---|
| Provider Enumeration Date | 09/27/2006 |
| Last Update Date | 04/20/2022 |
| Certification Date | 04/20/2022 |
| Medicare PECOS PAC ID | 5799784922 |
|---|---|
| Medicare Enrollment ID | O20061215000196 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164513388 | NPI | - | NPPES |
| CTGA000475 | Other | CT | DMHAS/ SAGA |
| 010016342CT02 | Other | CT | ANTHEM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | C-0008 (Connecticut) | Primary |
| Provider Name | Emily K Stagg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770861007 PECOS PAC ID: 6103084322 Enrollment ID: I20120220000665 |
| Provider Name | Donna S Grisham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508804352 PECOS PAC ID: 7719128560 Enrollment ID: I20130722000184 |
| Provider Name | Marissa Garfunkel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710384748 PECOS PAC ID: 2466778774 Enrollment ID: I20150304001431 |
| Provider Name | Michele Ann Britton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841727153 PECOS PAC ID: 7113290297 Enrollment ID: I20170912002221 |
| Provider Name | Dana E Smart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639657273 PECOS PAC ID: 8729332663 Enrollment ID: I20181113002211 |
| Provider Name | Donella Crenshaw |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568890580 PECOS PAC ID: 8224415286 Enrollment ID: I20220512000348 |
| Provider Name | Lindsey Laudano |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154045805 PECOS PAC ID: 0840668240 Enrollment ID: I20221116000295 |
| Provider Name | Dana Wetmore |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871876268 PECOS PAC ID: 7810336542 Enrollment ID: I20240415002130 |
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