Organization · Type 2 NPI

Ketamine Center LLC

Mental Health Clinic/Center (Including Community Mental Health Center) · Milford, CT

NPI number 1720866916 Active

Practice location

232 Boston Post Rd Ste 13
Milford, CT 06460-3158

Call (203) 701-6388 Map

Fax (203) 306-3134

Other practice locations

1720 Post Rd E Ste 211, Westport, CT 06880-5643 · (203) 701-6388

Specialties and licenses

Taxonomy	Code	License
Mental Health Clinic/Center (Including Community Mental Health Center) Primary	261QM0801X	None listed

Mental Health Clinic/Center (Including Community Mental Health Center): Definition to come...

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NPI record

NPI: 1720866916
Entity type: Organization (Type 2)
Issued: Sep 19, 2023
Last updated: Nov 30, 2023
Status: Active

Other names

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Ketamine Center of Connecticut · doing business as
Ketamine Center of Connecticut · doing business as

Authorized official

Al Gene Ejusa Ang
Office Manager
(860) 552-7592

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1720866916

Ketamine Center LLC's National Provider Identifier is 1720866916, issued on Sep 19, 2023. The primary taxonomy on file is Mental Health Clinic/Center (Including Community Mental Health Center) (261QM0801X), and the practice location is in Milford, CT. The record was last updated on Nov 30, 2023.