| Intraspectus, Llc | |
|
93 Lyon St New Haven CT 06511-4925 | |
| (203) 676-0880 | |
| Not Available |
| Full Name | Intraspectus, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 93 Lyon St, New Haven, Connecticut |
| Authorized Official Name and Position | Jeffrey Paul Kerekes (MANAGING MEMBER) |
| Authorized Official Contact | 2036760880 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Intraspectus, Llc 93 Lyon St New Haven CT 06511-4925 Ph: (203) 676-0880 | Intraspectus, Llc 93 Lyon St New Haven CT 06511-4925 Ph: (203) 676-0880 |
| NPI Number | 1942274618 |
|---|---|
| Provider Enumeration Date | 02/17/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942274618 | NPI | - | NPPES |
| 333779 | Other | CT | MHN |
| 140005553CT01 | Other | CT | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 005553 (Connecticut) | Primary |
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