Healthcare Provider Details

I. General information

NPI: 1366441933
Provider Name (Legal Business Name): PRAMILA NATHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 CHERRY ST PSYCHOTHERAPY CENTER FOR CHILDREN ADULTS AND FAMILIES
MILFORD CT
06460-3555
US

IV. Provider business mailing address

204 CHERRY ST PSYCHOTHERAPY CENTER FOR CHILDREN ADULTS AND FAMILIES
MILFORD CT
06460-3502
US

V. Phone/Fax

Practice location:
  • Phone: 203-876-0545
  • Fax: 203-876-0814
Mailing address:
  • Phone: 203-876-0545
  • Fax: 203-876-0814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number022757
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number022757
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number022757
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: