Organization
MASONICARE BEHAVIORAL HEALTH, LLC
Active
Organization
MASONICARE BEHAVIORAL HEALTH, LLC
Active
Parent organization
MASONICARE PRIMARY CARE PHYSICIANS, PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MASONICARE PRIMARY CARE PHYSICIANS, PC
Authorized official
JOHN TIBBETTS (AUTHORIZED OFFICIAL)
(203) 265-5720
Entity
Organization
Contact information
Practice address
67 MASONIC AVE, 1ST FLOOR, WALLINGFORD, CT 06492-3095
(203) 265-5720
(203) 679-5623
Mailing address
67 MASONIC AVE, 1ST FLOOR, WALLINGFORD, CT 06492-3095
(203) 265-5720
(203) 679-5623
Taxonomy
Speciality
Code
Description
License number
State
2084P0805X
Geriatric Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004183050
—
CT
Enumeration date
12/16/2005
Last updated
06/06/2014
Update your record
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