Organization
IMAGE OF LIGHT MENTAL HEALTH SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRIAM HAYNES APRN (OWNER)
(860) 299-6677
Entity
Organization
Contact information
Practice address
45 S MAIN ST STE 70, WEST HARTFORD, CT 06107
(860) 299-6677
Mailing address
53 BURNWOOD DR, BLOOMFIELD, CT 06002-2235
(860) 299-6677
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
CT
Other
Enumeration date
04/03/2018
Last updated
07/09/2018
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