Provider Demographics
NPI:1366958480
Name:MANSFIELD MENTAL HEALTH AND ADDICTION MEDICINE
Entity type:Organization
Organization Name:MANSFIELD MENTAL HEALTH AND ADDICTION MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GENGYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-842-8826
Mailing Address - Street 1:18E LEDGEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1693
Mailing Address - Country:US
Mailing Address - Phone:860-942-8826
Mailing Address - Fax:
Practice Address - Street 1:18-E LEDGEBROOK DRIVE
Practice Address - Street 2:18-E
Practice Address - City:MANSFIELD CTR
Practice Address - State:CT
Practice Address - Zip Code:06250
Practice Address - Country:US
Practice Address - Phone:347-872-3612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084A0401X
CT542662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty