Healthcare Provider Details

I. General information

NPI: 1750466744
Provider Name (Legal Business Name): ELEANOR MARIE FRITZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 05/30/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 COTTAGE GROVE RD STE C210
BLOOMFIELD CT
06002-4207
US

IV. Provider business mailing address

PSCYHOLOGICAL HEALTH ASSOCIATES C/O ELEANOR FRITZ 701 COTTAGE GROVE ROAD SUITE C210
BLOOMFIELD CT
06002-2141
US

V. Phone/Fax

Practice location:
  • Phone: 860-218-4315
  • Fax:
Mailing address:
  • Phone: 860-233-9772
  • Fax: 860-236-9402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number000539
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number000539
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: