Healthcare Provider Details

I. General information

NPI: 1518173715
Provider Name (Legal Business Name): ELIZABETH E. BRAINERD N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 BOSTON ST
GUILFORD CT
06437-2817
US

IV. Provider business mailing address

35 BOSTON ST
GUILFORD CT
06437-2817
US

V. Phone/Fax

Practice location:
  • Phone: 203-738-0020
  • Fax: 203-453-5684
Mailing address:
  • Phone: 203-738-0020
  • Fax: 203-453-5684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number237
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: