Healthcare Provider Details

I. General information

NPI: 1841735859
Provider Name (Legal Business Name): CONNECTICUT NATURAL HEALTH SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2016
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 EAST CENTER ST
MANCHESTER CT
06040
US

IV. Provider business mailing address

106 ROUTE 66 EAST
COLUMBIA CT
06237
US

V. Phone/Fax

Practice location:
  • Phone: 860-533-0179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000397
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number55300
License Number StateCT

VIII. Authorized Official

Name: LAUREN YOUNG
Title or Position: PHYSICIAN/OWNER
Credential: ND
Phone: 860-533-0179