Healthcare Provider Details

I. General information

NPI: 1396081162
Provider Name (Legal Business Name): MARIE CAROLLE JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: N/A N/A N/A NP

II. Dates (important events)

Enumeration Date: 12/21/2012
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 BRIDGEPORT AVE
MILFORD CT
06460-3142
US

IV. Provider business mailing address

80 HOOKER RD
BRIDGEPORT CT
06610-1316
US

V. Phone/Fax

Practice location:
  • Phone: 203-878-6365
  • Fax: 203-301-2397
Mailing address:
  • Phone: 203-345-3095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number005094
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number005094
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: