Healthcare Provider Details

I. General information

NPI: 1922681279
Provider Name (Legal Business Name): DOROTHY DENIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 WHITNEY AVE
HAMDEN CT
06518-3233
US

IV. Provider business mailing address

14 BRAE LOCH WAY
SHELTON CT
06484-5952
US

V. Phone/Fax

Practice location:
  • Phone: 203-298-9005
  • Fax:
Mailing address:
  • Phone: 184-522-2465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number009659
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: