| Central Connecticut Behavioral Health Llc | |
|
2275 Silas Deane Hwy Rocky Hill CT 06067-2329 | |
| (860) 736-4139 | |
| Not Available |
| Full Name | Central Connecticut Behavioral Health Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2275 Silas Deane Hwy, Rocky Hill, Connecticut |
| Authorized Official Name and Position | Richard Frank Comshaw (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8607364139 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Central Connecticut Behavioral Health Llc 238 Congdon St E Middletown CT 06457-2063 Ph: (860) 736-4139 | Central Connecticut Behavioral Health Llc 2275 Silas Deane Hwy Rocky Hill CT 06067-2329 Ph: (860) 736-4139 |
| NPI Number | 1043666480 |
|---|---|
| Provider Enumeration Date | 05/04/2016 |
| Last Update Date | 02/10/2023 |
| Certification Date | 02/10/2023 |
| Medicare PECOS PAC ID | 1951692706 |
|---|---|
| Medicare Enrollment ID | O20160624001721 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043666480 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 040063 (Connecticut) | Primary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 0001702 (Connecticut) | Secondary |
| Provider Name | Mohammad Dada |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457307043 PECOS PAC ID: 0042203051 Enrollment ID: I20051010000478 |
| Provider Name | Thuraya A Abdi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124272950 PECOS PAC ID: 0143381376 Enrollment ID: I20081206000082 |
| Provider Name | Richard Frank Comshaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639116957 PECOS PAC ID: 9335205194 Enrollment ID: I20090303000018 |
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