Provider Demographics
NPI:1588478135
Name:KELLY JAZIRI, M.D. PSYCHIATRIC SERVICES, LLC
Entity type:Organization
Organization Name:KELLY JAZIRI, M.D. PSYCHIATRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAZIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-889-3052
Mailing Address - Street 1:108 NEW LONDON TPKE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2645
Mailing Address - Country:US
Mailing Address - Phone:860-889-3052
Mailing Address - Fax:860-889-0926
Practice Address - Street 1:108 NEW LONDON TPKE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2645
Practice Address - Country:US
Practice Address - Phone:860-889-3052
Practice Address - Fax:860-889-0926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty