Masonicare Behavioral Health, LLC
NPI #1992781488 in Wallingford, Connecticut
Provider Information
- NPI Number
- 1992781488
- Entity Type
- Organization
- Organization Name
- Masonicare Behavioral Health, LLC
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- MASONICARE PRIMARY CARE PHYSICIANS, PC
- Primary Specialty
- Psychiatry & Neurology - Geriatric Psychiatry
- Enumeration Date
- Dec 16, 2005
- Last Updated
- Jun 6, 2014
Practice Location
- Address
- 67 MASONIC AVE
- Address 2
- 1ST FLOOR
- City
- Wallingford
- State
- Connecticut
- ZIP Code
- 06492-3095
- Phone
- (203) 265-5720
Authorized Official
- Name
- JOHN TIBBETTS
- Title
- AUTHORIZED OFFICIAL
- Phone
- (203) 265-5720
Specialties & Taxonomy Codes
| Specialty |
|---|
| Psychiatry & Neurology - Geriatric Psychiatry — Geriatric Psychiatry |
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