Healthcare Provider Details

I. General information

NPI: 1992057772
Provider Name (Legal Business Name): WILLOW TREATMENT & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 CONNOLLY PARKWAY; BUILDING 2C-207 WILBUR CROSS COMMONS
HAMDEN CT
06514
US

IV. Provider business mailing address

60 CONNOLLY PARKWAY; BUILDING 2C-207 WILBUR CROSS COMMONS
HAMDEN CT
06514
US

V. Phone/Fax

Practice location:
  • Phone: 203-535-0318
  • Fax:
Mailing address:
  • Phone: 203-535-0318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number001265
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number001265
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number001265
License Number StateCT

VIII. Authorized Official

Name: MRS. KATHRYN CAMIZZI
Title or Position: PRESIDENT
Credential: APRN
Phone: 203-535-0318