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Organization

SOUTHWEST TRAUMA INFORMED INTEGRATED CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
FELISHA MACK DNP, APRN (PMHNP-BC, FNP-BC)
(475) 298-3887
Entity
Organization

Contact information

Practice address
125 SHANLEY ST, STRATFORD, CT 06615-6944
(475) 298-3887
Mailing address
125 SHANLEY ST, STRATFORD, CT 06615-6944

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary

Other

Enumeration date
06/29/2022
Last updated
06/29/2022
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