Healthcare Provider Details

I. General information

NPI: 1811221955
Provider Name (Legal Business Name): NEW HAVNE NATUROPATHIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1079 WHALLEY AVE SUITE 4
NEW HAVEN CT
06515-1783
US

IV. Provider business mailing address

1079 WHALLEY AVE SUITE 4
NEW HAVEN CT
06515-1783
US

V. Phone/Fax

Practice location:
  • Phone: 203-387-5015
  • Fax: 203-387-3500
Mailing address:
  • Phone: 203-387-5015
  • Fax: 203-387-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number#000301
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number#000301
License Number StateCT

VIII. Authorized Official

Name: DR. JENNIFER DOROTHY BOTWICK
Title or Position: OWNER/PHYSICIAN
Credential: N.D.
Phone: 203-387-5015