KETAMINE CENTER LLC NPI 1720866916

NPI Information

NPI: 1720866916
Provider Name: KETAMINE CENTER LLC

Doing Business As: KETAMINE CENTER OF CONNECTICUT

Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
232 BOSTON POST RD STE 13
MILFORD, CT
ZIP 06460
Phone: (203) 701-6388
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KETAMINE CENTER LLC is a mental health (including community mental health center) clinic center in Milford, CT. KETAMINE CENTER LLC NPI is 1720866916. The provider is registered as an organization entity type.
The provider Is Doing Business As Ketamine Center Of Connecticut.

The provider's business location address is:

232 BOSTON POST RD STE 13
MILFORD, CT
ZIP 06460-158
Phone: (203) 701-6388
Fax: (203) 306-3134

The provider's authorized official is Al Gene Ejusa Ang .
The authorized official title is Office Manager and has the following contact phone number (860) 552-7592.

The enumeration date for this NPI number is 9/19/2023 and was last updated on 11/30/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			Yes

What is NPI?

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This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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