Healthcare Provider Details

I. General information

NPI: 1396135851
Provider Name (Legal Business Name): JAMIZE BARLOW-PETTIFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 ROUTE 6
COLUMBIA CT
06237-1125
US

IV. Provider business mailing address

233 ROUTE 6 PO BOX 200
COLUMBIA CT
06237-1125
US

V. Phone/Fax

Practice location:
  • Phone: 860-228-4480
  • Fax: 860-779-5437
Mailing address:
  • Phone: 860-228-4480
  • Fax: 860-779-5437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: