Healthcare Provider Details

I. General information

NPI: 1194935841
Provider Name (Legal Business Name): LORETTA P GORCENSKI RNC, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 LATHAM HILL RD
COLUMBIA CT
06237-1408
US

IV. Provider business mailing address

14 LATHAM HILL RD
COLUMBIA CT
06237-1408
US

V. Phone/Fax

Practice location:
  • Phone: 860-228-4194
  • Fax: 860-228-1428
Mailing address:
  • Phone: 860-228-4194
  • Fax: 860-228-1428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR37687
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: