Healthcare Provider Details

I. General information

NPI: 1861487852
Provider Name (Legal Business Name): JOAN K DREYFUS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WASHINGTON AVE SUITE 102
HAMDEN CT
06518-3271
US

IV. Provider business mailing address

1890 DIXWELL AVE SUITE 207
HAMDEN CT
06514-3122
US

V. Phone/Fax

Practice location:
  • Phone: 203-407-6400
  • Fax: 203-281-5555
Mailing address:
  • Phone: 203-404-6444
  • Fax: 203-407-6442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number000931
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number000931
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: