# REVIVE PSYCHIATRY SERVICES

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

## Provider details

- **NPI number:** 1831844877
- **Authorized official:** LINTON KINLOCK APRN (PSYCHIATRIC NURSE PRACTITIONER)
- **Authorized official phone:** (203) 536-8533

## Contact information

- **Practice address:** 130 POPLAR ST, BRIDGEPORT, CT 06605-1925
- **Practice address phone:** (203) 536-8533
- **Mailing address:** 130 POPLAR ST, BRIDGEPORT, CT 06605-1925

## 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:** 02/17/2022
- **Last updated:** 02/17/2022