Organization
MANCHESTER MEMORIAL HOSPITAL
Active
Parent organization
MANCHESTER MEMORIAL HOSPITAL
Other names
Manchester Memoril Hospital Psychiatric
Organization subpart
Yes
Provider details
NPI number
Legal business name
MANCHESTER MEMORIAL HOSPITAL
Authorized official
PETER KARL (CEO)
(860) 646-1222
Entity
Organization
Contact information
Practice address
320 MAIN ST, MANCHESTER, CT 06040-4144
(860) 646-1222
Mailing address
71 HAYNES ST, MANCHESTER, CT 06040-4131
(860) 646-1222
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
0048
CT
2084P0800X
Psychiatry Physician
0048
CT
2084P0802X
Addiction Psychiatry Physician
0048
CT
2084P0804X
Child & Adolescent Psychiatry Physician
0048
CT
2084P0805X
Geriatric Psychiatry Physician
0048
CT
273R00000X
Psychiatric Hospital Unit
Primary
0048
CT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7228711
—
CT
Enumeration date
06/14/2006
Last updated
01/26/2015
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