Organization
CONNECTICUT BEHAVIORAL HEALTH ASSOC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BASSAM AWWA MD (MEDICAL DIRECTOR)
(860) 437-6914
Entity
Organization
Contact information
Practice address
41 FAIR HARBOUR PL, NEW LONDON, CT 06320-4710
(860) 437-6914
(860) 437-6920
Mailing address
41 FAIR HARBOUR PL, NEW LONDON, CT 06320-4710
(860) 437-6914
(860) 437-6920
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004192324
—
CT
05
—
004195774
—
CT
05
—
004199271
—
CT
05
—
004255388
—
CT
05
—
004255411
—
CT
05
—
008008065
—
CT
Enumeration date
10/17/2006
Last updated
11/16/2015
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