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Organization
CONNECTICUT BEHAVIORAL HEALTH ASSOC, P.C.
Active
Organization
CONNECTICUT BEHAVIORAL HEALTH ASSOC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BASSAM AWWA MD (MEDICAL DIRECTOR)
(860) 437-6914
Entity
Organization
Contact information
Practice address
41 FAIR HARBOUR PL, NEW LONDON, CT 06320-4710
(860) 437-6914
(860) 437-6920
Mailing address
41 FAIR HARBOUR PL, NEW LONDON, CT 06320-4710
(860) 437-6914
(860) 437-6920
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004192324
—
CT
05
—
004195774
—
CT
05
—
004199271
—
CT
05
—
004255388
—
CT
05
—
004255411
—
CT
05
—
008008065
—
CT
Enumeration date
10/17/2006
Last updated
11/16/2015
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