| Phoenix Professional Services | |
|
29 Connecticut Blvd East Hartford CT 06108-3008 | |
| (860) 778-1257 | |
| Not Available |
| Full Name | Phoenix Professional Services |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 29 Connecticut Blvd, East Hartford, Connecticut |
| Authorized Official Name and Position | Tamar Draughn (CLINICAL DIRECTOR) |
| Authorized Official Contact | 8606809440 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Professional Services 29 Connecticut Blvd East Hartford CT 06108-3008 Ph: (860) 778-1257 | Phoenix Professional Services 29 Connecticut Blvd East Hartford CT 06108-3008 Ph: (860) 778-1257 |
| NPI Number | 1801214986 |
|---|---|
| Provider Enumeration Date | 04/04/2014 |
| Last Update Date | 06/19/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801214986 | NPI | - | NPPES |
| 008046849 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 002311 (Connecticut) | Primary |
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