Healthcare Provider Details

I. General information

NPI: 1427343441
Provider Name (Legal Business Name): MAPIRIPANA-YURUPARI OF NEW ENGLAND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 FOREST RD SUITE B
NEW HAVEN CT
06515-2443
US

IV. Provider business mailing address

1165 FOREST ROAD SUITE B
NEW HAVEN CT
06515-2443
US

V. Phone/Fax

Practice location:
  • Phone: 203-691-9611
  • Fax:
Mailing address:
  • Phone: 203-691-9611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1000X
TaxonomyMigrant Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MAURICIO ROMERO-GONZALEZ
Title or Position: PRESIDENT
Credential: MD, MPH
Phone: 203-606-9636