Provider Demographics
NPI:1871943514
Name:JP BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:JP BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C0-OWNER- CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PURVI
Authorized Official - Middle Name:SHAH
Authorized Official - Last Name:VANDERPLOEG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-205-6080
Mailing Address - Street 1:129 PENN DR
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1041
Mailing Address - Country:US
Mailing Address - Phone:516-205-6080
Mailing Address - Fax:
Practice Address - Street 1:45 S MAIN ST
Practice Address - Street 2:SUITE 70
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2441
Practice Address - Country:US
Practice Address - Phone:516-205-6080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002878103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty