Organization
REVIVE PSYCHIATRY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINTON KINLOCK APRN (PSYCHIATRIC NURSE PRACTITIONER)
(203) 536-8533
Entity
Organization
Contact information
Practice address
130 POPLAR ST, BRIDGEPORT, CT 06605-1925
(203) 536-8533
Mailing address
130 POPLAR ST, BRIDGEPORT, CT 06605-1925
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6024487
—
CT
Enumeration date
02/17/2022
Last updated
02/17/2022
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