Healthcare Provider Details

I. General information

NPI: 1598737314
Provider Name (Legal Business Name): KIM CLANCY BROWNELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 11/14/2013
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

PO BOX 415933 HARTFORD HOSPITAL PROFESSIONAL SERVICES
BOSTON MA
02241-5933
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-7493
  • Fax:
Mailing address:
  • Phone: 860-545-7602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number041454
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number041454
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number041454
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: