Healthcare Provider Details

I. General information

NPI: 1528261294
Provider Name (Legal Business Name): GUITA EPSTEIN WILF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GUITA EPSTEIN EPSTEIN WILF MD

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 GEORGE ST
NEW HAVEN CT
06511-5322
US

IV. Provider business mailing address

93 MUMFORD RD
NEW HAVEN CT
06515-2431
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-4080
  • Fax:
Mailing address:
  • Phone: 203-668-7848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberCT 20635
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: