| Psychological Health Center Of Suffield, Llc | |
|
230b Mountain Rd Lower Level Suffield CT 06078-2082 | |
| (860) 254-5991 | |
| Not Available |
| Full Name | Psychological Health Center Of Suffield, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 230b Mountain Rd, Suffield, Connecticut |
| Authorized Official Name and Position | Shannon Lee Ayotte Stauffer (OWNER) |
| Authorized Official Contact | 8609897875 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychological Health Center Of Suffield, Llc 880 Burbank Ave Ste 2b Suffield CT 06078-1459 Ph: (860) 989-7875 | Psychological Health Center Of Suffield, Llc 230b Mountain Rd Lower Level Suffield CT 06078-2082 Ph: (860) 254-5991 |
| NPI Number | 1104077759 |
|---|---|
| Provider Enumeration Date | 10/01/2008 |
| Last Update Date | 03/28/2023 |
| Certification Date | 03/28/2023 |
| Medicare PECOS PAC ID | 2466455746 |
|---|---|
| Medicare Enrollment ID | O20060808000116 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104077759 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | 006144 (Connecticut) | Primary |
| Provider Name | Shannon L Ayotte Stauffer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720035041 PECOS PAC ID: 2567465842 Enrollment ID: I20060808000109 |
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