| Connecticut Renaissance, Inc. | |
|
141 Franklin St Stamford CT 06901-1014 | |
| (203) 602-4441 | |
| (203) 602-7782 |
| Full Name | Connecticut Renaissance, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 141 Franklin St, Stamford, Connecticut |
| Authorized Official Name and Position | Joy Nicole Pendola (COO) |
| Authorized Official Contact | 2033365225 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Connecticut Renaissance, Inc. 350 Fairfield Ave Suite 701 Bridgeport CT 06604-6014 Ph: (203) 336-5225 | Connecticut Renaissance, Inc. 141 Franklin St Stamford CT 06901-1014 Ph: (203) 602-4441 |
| NPI Number | 1700893807 |
|---|---|
| Provider Enumeration Date | 08/02/2006 |
| Last Update Date | 07/08/2019 |
| Medicare PECOS PAC ID | 0941253728 |
|---|---|
| Medicare Enrollment ID | O20050222000611 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700893807 | NPI | - | NPPES |
| 004214277 | Medicaid | CT |
| Provider Name | Robert Guerrera |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033232228 PECOS PAC ID: 4789645458 Enrollment ID: I20041026000216 |
| Provider Name | Lori Pelosi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649521352 PECOS PAC ID: 2668624578 Enrollment ID: I20121128000425 |
| Provider Name | Jennifer Anne Nolan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528502853 PECOS PAC ID: 4688916778 Enrollment ID: I20190418002502 |
| Provider Name | Jennifer Reid |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568094894 PECOS PAC ID: 8325422488 Enrollment ID: I20220908003068 |
| Provider Name | Melodie Keen |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1689945438 PECOS PAC ID: 2860845559 Enrollment ID: I20240130000691 |
| Provider Name | Kelly N O'keefe |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1093301194 PECOS PAC ID: 9032562509 Enrollment ID: I20240131003362 |
| Provider Name | Dawn E Patston |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1508137381 PECOS PAC ID: 2062860901 Enrollment ID: I20240212003340 |
| Provider Name | Amy A Vitale |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821424706 PECOS PAC ID: 7416308705 Enrollment ID: I20240220003342 |
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