Organization
WAIRE LLC
Active
Other names
ellington behavioral health
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERUM SHAHAB MD (OWNER)
(860) 871-5402
Entity
Organization
Contact information
Practice address
105 WEST RD, ELLINGTON, CT 06029-5700
(860) 871-5402
(860) 871-5413
Mailing address
105 WEST RD, ELLINGTON, CT 06029-4247
(860) 871-5402
(860) 871-5413
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
043112
CT
2084P0802X
Addiction Psychiatry Physician
043112
CT
261Q00000X
Clinic/Center
043112
CT
Other
Enumeration date
10/03/2008
Last updated
02/24/2015
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