| New Leaf Psychiatry Llc | |
|
2661 Whitney Ave Hamden CT 06518-2900 | |
| (203) 936-8578 | |
| Not Available |
| Full Name | New Leaf Psychiatry Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2661 Whitney Ave, Hamden, Connecticut |
| Authorized Official Name and Position | Daedly Potusek (OWNER) |
| Authorized Official Contact | 2035363161 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Leaf Psychiatry Llc Po Box 4191 Hamden CT 06514-0191 Ph: () - | New Leaf Psychiatry Llc 2661 Whitney Ave Hamden CT 06518-2900 Ph: (203) 936-8578 |
| NPI Number | 1063139202 |
|---|---|
| Provider Enumeration Date | 10/27/2022 |
| Last Update Date | 10/27/2022 |
| Certification Date | 10/27/2022 |
| Medicare PECOS PAC ID | 1850742024 |
|---|---|
| Medicare Enrollment ID | O20240111004373 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063139202 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Daedly Potusek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578022166 PECOS PAC ID: 0840524948 Enrollment ID: I20190624001984 |
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