Healthcare Provider Details

I. General information

NPI: 1477325256
Provider Name (Legal Business Name): NYLSA HARDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 WETHERSFIELD AVE
HARTFORD CT
06114-1420
US

IV. Provider business mailing address

331 WETHERSFIELD AVE
HARTFORD CT
06114-1420
US

V. Phone/Fax

Practice location:
  • Phone: 860-232-4511
  • Fax:
Mailing address:
  • Phone: 860-236-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17088
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: