# WEVOLVE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760148290
- **Authorized official:** MAURICE BUNNELL (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (475) 202-3318

## Contact information

- **Practice address:** 4 CORPORATE DR STE 396, SHELTON, CT 06484-6266
- **Practice address phone:** (475) 202-3450
- **Practice address fax:** (203) 712-7130
- **Mailing address:** 4 CORPORATE DR STE 396, SHELTON, CT 06484-6266
- **Mailing address phone:** (475) 202-3450
- **Mailing address fax:** (203) 712-7130

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/09/2021
- **Last updated:** 02/09/2022