Healthcare Provider Details

I. General information

NPI: 1427814169
Provider Name (Legal Business Name): BREANNA ROSE HUNTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 MAIN ST
BERLIN CT
06037-2665
US

IV. Provider business mailing address

143 JEFFERSON LN
EAST HARTFORD CT
06118-2110
US

V. Phone/Fax

Practice location:
  • Phone: 860-785-0729
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number16140
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: