Healthcare Provider Details

I. General information

NPI: 1467481341
Provider Name (Legal Business Name): ELISABETH MARIJKE KRESSLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WILDWOOD MEDICAL CENTER
ESSEX CT
06426
US

IV. Provider business mailing address

2 WILDWOOD MEDICAL CENTER
ESSEX CT
06426
US

V. Phone/Fax

Practice location:
  • Phone: 860-767-2186
  • Fax: 860-767-2186
Mailing address:
  • Phone: 860-767-2186
  • Fax: 860-767-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number033087
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number033087
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: