Healthcare Provider Details

I. General information

NPI: 1881416626
Provider Name (Legal Business Name): JACQUELINE CUADRADO LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 COLUMBUS AVE
NEW HAVEN CT
06519-1233
US

IV. Provider business mailing address

58 OREGON AVE
EAST HAVEN CT
06512-4119
US

V. Phone/Fax

Practice location:
  • Phone: 203-503-3581
  • Fax:
Mailing address:
  • Phone: 203-824-8147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7363
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: