National Provider Identifier Database

CONNECTICUT BEHAVIORAL HEALTH ASSOC PC
Mental Health (Including Community Mental Health Center)

Contact Information

CONNECTICUT BEHAVIORAL HEALTH ASSOC, P.C.
41 FAIR HARBOUR PL
NEW LONDON, CT  06320-4710
Phone: 860-437-6914
Fax: 860-437-6920
Website:
Specialty Taxonomy Code
* Mental Health (Including Community Mental Health Center) 261QM0801X
Clinical 103TC0700X
Clinical 1041C0700X
Marriage & Family Therapist 106H00000X
Professional 101YP2500X
Psychiatric/Mental Health 363LP0808X
Psychiatry 2084P0800X

* Indicates primary specialty

NPI Profile & details for CONNECTICUT BEHAVIORAL HEALTH ASSOC, P.C.

NPI Number 1629158126
Legal business name
LBN		 CONNECTICUT BEHAVIORAL HEALTH ASSOC, P.C.
Authorized official BASSAM AWWA - (MEDICAL DIRECTOR)
Entity Organization
Organization subpart No
Enumeration date 10/17/2006
Last updated 11/16/2015 - About 11 years ago
Sole proprietor1 Not specified
Identifiers
  • CT Medicaid: 004192324
  • CT Medicaid: 004195774
  • CT Medicaid: 004199271
  • CT Medicaid: 004255388
  • CT Medicaid: 004255411
  • CT Medicaid: 008008065

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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