Healthcare Provider Details

I. General information

NPI: 1770127318
Provider Name (Legal Business Name): GBAPP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 BARNUM AVE
BRIDGEPORT CT
06610-3237
US

IV. Provider business mailing address

1470 BARNUM AVE
BRIDGEPORT CT
06610-3237
US

V. Phone/Fax

Practice location:
  • Phone: 203-366-8255
  • Fax: 203-338-8453
Mailing address:
  • Phone: 203-366-8255
  • Fax: 203-338-8453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. RUDY FEUDO
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 203-366-8255