Provider Demographics
NPI:1609672518
Name:VIAREPOSE MENTAL HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:VIAREPOSE MENTAL HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:MARVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD-DIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-374-8538
Mailing Address - Street 1:35 TALCOTTVILLE RD STE 10
Mailing Address - Street 2:
Mailing Address - City:VERNON ROCKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06066-5261
Mailing Address - Country:US
Mailing Address - Phone:860-374-8538
Mailing Address - Fax:
Practice Address - Street 1:843 MAIN ST STE 15
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6020
Practice Address - Country:US
Practice Address - Phone:860-999-6248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-21
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty