Healthcare Provider Details

I. General information

NPI: 1548332448
Provider Name (Legal Business Name): JOANNE E CYR-CALLAGHAN BC HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 PINE ST SUITE B
BRISTOL CT
06010-6960
US

IV. Provider business mailing address

72 PINE ST SUITE B
BRISTOL CT
06010-6960
US

V. Phone/Fax

Practice location:
  • Phone: 860-506-3720
  • Fax: 860-506-3721
Mailing address:
  • Phone: 860-506-3720
  • Fax: 860-506-3721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number000198
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: