Healthcare Provider Details

I. General information

NPI: 1821847443
Provider Name (Legal Business Name): ISABEL MESQUITA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 PADDOCK AVE
MERIDEN CT
06450-7044
US

IV. Provider business mailing address

136 HIGH HILL RD
WALLINGFORD CT
06492-1934
US

V. Phone/Fax

Practice location:
  • Phone: 877-577-3233
  • Fax:
Mailing address:
  • Phone: 203-907-9302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13979
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: