Provider Demographics
NPI:1285391474
Name:WCT BEHAVIORAL HEALTH & MEDICATION MANAGEMENT PLLC
Entity type:Organization
Organization Name:WCT BEHAVIORAL HEALTH & MEDICATION MANAGEMENT PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BREW
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-302-8671
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:CT
Mailing Address - Zip Code:06752-0266
Mailing Address - Country:US
Mailing Address - Phone:203-518-8218
Mailing Address - Fax:203-648-4172
Practice Address - Street 1:211 SCHRAFFTS DR
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3222
Practice Address - Country:US
Practice Address - Phone:203-518-8218
Practice Address - Fax:844-833-5610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008053705Medicaid