Provider Demographics
NPI:1114748555
Name:COMPLETE KETAMINE SOLUTIONS OF STAMFORD LLC
Entity type:Organization
Organization Name:COMPLETE KETAMINE SOLUTIONS OF STAMFORD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:SPINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-595-5340
Mailing Address - Street 1:80 MILL RIVER ST STE 1500
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3756
Mailing Address - Country:US
Mailing Address - Phone:203-595-5340
Mailing Address - Fax:203-595-5341
Practice Address - Street 1:80 MILL RIVER ST STE 1500
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3756
Practice Address - Country:US
Practice Address - Phone:203-595-5340
Practice Address - Fax:203-595-5341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center