Organization
INTRASPECTUS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY PAUL KEREKES MSSW, LCSW (MANAGING MEMBER)
(203) 676-0880
Entity
Organization
Contact information
Practice address
93 LYON ST, NEW HAVEN, CT 06511-4925
(203) 676-0880
Mailing address
93 LYON ST, NEW HAVEN, CT 06511-4925
(203) 676-0880
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
005553
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140005553CT01
BCBS
CT
01
—
333779
MHN
CT
Enumeration date
02/17/2006
Last updated
08/22/2020
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