Healthcare Provider Details

I. General information

NPI: 1205593209
Provider Name (Legal Business Name): KATARZYNA TESZ PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2021
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CHAMBERLAIN HWY
BERLIN CT
06037-1921
US

IV. Provider business mailing address

26 CHAMBERLAIN HWY
BERLIN CT
06037-1921
US

V. Phone/Fax

Practice location:
  • Phone: 860-893-0040
  • Fax:
Mailing address:
  • Phone: 860-893-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2021085654
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: