Healthcare Provider Details

I. General information

NPI: 1811390214
Provider Name (Legal Business Name): ANTOINETTE RAYNOR M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

896 ASYLUM AVE
HARTFORD CT
06105-1901
US

IV. Provider business mailing address

896 ASYLUM AVE
HARTFORD CT
06105-1901
US

V. Phone/Fax

Practice location:
  • Phone: 860-522-8241
  • Fax: 860-524-8143
Mailing address:
  • Phone: 860-522-8241
  • Fax: 860-524-8143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: