IMAGE OF LIGHT MENTAL HEALTH SERVICES, LLC (NPI# 1124524798) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124524798 |
| Entity Type | Organization |
| Organization Name | IMAGE OF LIGHT MENTAL HEALTH SERVICES, LLC |
| Practice Address |
45 S Main St Ste 70 West Hartford CT 06107 |
| Mailing Address |
53 Burnwood Dr Bloomfield CT 06002-2235 |
| Practice Telephone | 8602996677 |
| Mailing Telephone | 8602996677 |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2018-07-09 |
| Authorized Official Name | MIRIAM HAYNES (OWNER) |
| Authorized Official Telephone | 8602996677 |
| Authorized Official Credential | APRN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
CT | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3 Barnard Ln Ste 309, Bloomfield, CT 060022495 | 2032996677 |
| Street Address |
45 S MAIN ST STE 70 |
| City | WEST HARTFORD |
| State | CT |
| Zip Code | 06107 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538783659 | Briana Deslauriers | Audiologist | Solinsky Hearing Center, 1013 Farmington Avenue, West Hartford, CT 06107 | 2020-06-04 |
| 1750851366 | Candyce Yvonne Scott | Counselor | 61 S Main St Ste 310, West Hartford, CT 06107 | 2018-11-27 |
| 1235632498 | Leila Fussell | Student in an Organized Health Care Education/Training Program | 175 Garfield Rd, West Hartford, CT 06107 | 2018-03-14 |
| 1568818169 | Gail Southard Canzano | Psychologist | 81 S. Main St, West Hartford, CT 06107 | 2016-05-12 |
| 1922470939 | Optimal Wellness of West Hartford | Family Medicine | 1001 Farmington Ave., West Hartford, CT 06107 | 2015-10-29 |
| 1518369925 | Maria Eugenia Garcia-ayala | Psychiatry & Neurology | 65 Memorial Rd Ste 508, West Hartford, CT 06107 | 2014-09-17 |
| 1376884981 | Robert Moss | Pediatrics | 174 Wood Pond Road, West Hartford, CT 06107 | 2013-03-06 |
| 1659630960 | Michael John Grille | Anesthesiology | 65 Memorial Rd #435, Hartford Hospital Pain Treatment Center, West Hartford, CT 06107 | 2012-05-07 |
| 1518268010 | Parsons Health Co. Inc | Legal Medicine | 61 So Main Street, Suite 202, West Hartford, CT 06107 | 2010-11-15 |
| 1891005005 | Peter S Katz Dmd | Dentist | 125 La Salle Road, Suite 306, West Hartford, CT 06107 | 2010-10-21 |
| Find all providers in zip 06107 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699237024 | Cherie Ann Bochenko | Nurse Practitioner | 16 Tumblebrook Ln, West Hartford, CT 06117-1457 | 2019-04-04 |
| 1144559543 | Laurie Kennedy | Nurse Practitioner | 8 Harwich Ln, West Hartford, CT 06117-1436 | 2009-12-14 |
| 1679132310 | Martha Barcelos Aprn, Pmhnp, LLC | Nurse Practitioner | 779 Farmington Ave, West Hartford, CT 06119-1674 | 2019-06-06 |
| 1275652851 | Margaret M Rudin | Nurse Practitioner | 65 Kane St, West Hartford, CT 06119-2110 | 2007-03-28 |
| 1952380842 | Geraldine S Pearson | Nurse Practitioner | 65 Kane St, West Hartford, CT 06119-2110 | 2006-01-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578164935 | Sheneese Denelle Charles | Nurse Practitioner | 22 Victoria Rd, New Britain, CT 06052-1536 | 2020-11-03 |
| 1396345179 | Kate Hanselman | Nurse Practitioner | 224 Saint John St # 3l, New Haven, CT 06511-4917 | 2020-10-29 |
| 1518565399 | Gina Kolstad | Nurse Practitioner | 279 Quarry Rd # 2, Glastonbury, CT 06033-3406 | 2020-10-13 |
| 1043818966 | Shakeria C Brown | Nurse Practitioner | 567 Millville Ave Apt 3-10, Naugatuck, CT 06770-2337 | 2020-10-13 |
| 1154937910 | Gregory Guion | Nurse Practitioner | 2275 Silas Deane Highway, 2nd Floor, Rocky Hill, CT 06067-2343 | 2020-09-17 |
| 1003425331 | Ryan Keenan | Nurse Practitioner | 34 Seaview Ave, West Haven, CT 06516-6846 | 2020-07-22 |
| 1649888256 | Healthy Minds Pllc | Nurse Practitioner | 40 Russ St, Hartford, CT 06106-1520 | 2020-07-20 |
| 1174131205 | Kimberly Levitt | Nurse Practitioner | 466 Ridgebury Rd, Ridgefield, CT 06877-1228 | 2020-07-15 |
| 1801414602 | Georgina Twumasi Mental Health LLC | Nurse Practitioner | 29 Wildwood Cir, South Windsor, CT 06074-1700 | 2020-07-08 |
| 1356978688 | Rachel Feit | Nurse Practitioner | 63 Pine Tree Dr, Stamford, CT 06906-1529 | 2020-03-25 |
| Find all providers with the same taxonomy | ||||
| City | WEST HARTFORD |
| Zip Code | 06107 |
Please comment or provide details below to improve the information on IMAGE OF LIGHT MENTAL HEALTH SERVICES, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.