Healthcare Provider Details

I. General information

NPI: 1750197638
Provider Name (Legal Business Name): RACHEL MARIE DUBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CRESCENT ST
NEW HAVEN CT
06515-1330
US

IV. Provider business mailing address

1538 ELLA T GRASSO BLVD
NEW HAVEN CT
06511-2920
US

V. Phone/Fax

Practice location:
  • Phone: 203-392-7278
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: