Healthcare Provider Details

I. General information

NPI: 1922910405
Provider Name (Legal Business Name): ANNABELLE MAVOY BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 PARK AVE
BRIDGEPORT CT
06604-1047
US

IV. Provider business mailing address

4000 PARK AVE
BRIDGEPORT CT
06604-1047
US

V. Phone/Fax

Practice location:
  • Phone: 203-371-7999
  • Fax:
Mailing address:
  • Phone: 860-371-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number172625
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: