Healthcare Provider Details

I. General information

NPI: 1699008326
Provider Name (Legal Business Name): CAREN BETH TEITELBAUM M.,D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RETREAT AVENUE HARTFORD HOSPITAL PSYCHIATRY DEPT
HARTFORD CT
06106-3310
US

IV. Provider business mailing address

P.O. BOX 40,000 DEPT 634 HARTFORD HOSPITAL PROFESSIONAL SERVICES
HARTFORD CT
06151-0634
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-7187
  • Fax:
Mailing address:
  • Phone: 860-545-7602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number044847
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number044847
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: