Healthcare Provider Details

I. General information

NPI: 1831428150
Provider Name (Legal Business Name): CARISSA L GONELL LNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARISSA SIMMONS LNM

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST
HARTFORD CT
06106-5501
US

IV. Provider business mailing address

2110 SILAS DEANE HWY
ROCKY HILL CT
06067-2313
US

V. Phone/Fax

Practice location:
  • Phone: 860-246-4029
  • Fax: 860-240-7072
Mailing address:
  • Phone: 860-258-3470
  • Fax: 860-571-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number000337
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: