Organization
GERICARE PSYCH LLC
Active
Other names
GeriCare Psych
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN BRENES MBA (CEO)
(203) 633-4560
Entity
Organization
Contact information
Practice address
464 WOLCOTT RD, WOLCOTT, CT 06716-2626
(203) 633-4560
Mailing address
464 WOLCOTT RD, WOLCOTT, CT 06716-2626
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TA0700X
Adult Development & Aging Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TP0016X
Prescribing (Medical) Psychologist
Primary
—
—
Other
Enumeration date
11/09/2009
Last updated
11/09/2009
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