Healthcare Provider Details

I. General information

NPI: 1013870021
Provider Name (Legal Business Name): LEAH M YAZMER CCLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 PRINCESS DRIVE, MADISON CT
MADISON CT
06443
US

IV. Provider business mailing address

164 PRINCESS DRIVE, MADISON CT
MADISON CT
06443
US

V. Phone/Fax

Practice location:
  • Phone: 860-674-0000
  • Fax:
Mailing address:
  • Phone: 860-674-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: