Healthcare Provider Details

I. General information

NPI: 1710703301
Provider Name (Legal Business Name): SARA E TRIPLETT-GUTAUKAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA E TRIPLETT

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 MAIN ST
NEW BRITAIN CT
06051-4204
US

IV. Provider business mailing address

20 STEVENS ST
BRISTOL CT
06010-2713
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-8192
  • Fax:
Mailing address:
  • Phone: 860-331-7073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: