Healthcare Provider Details

I. General information

NPI: 1467316349
Provider Name (Legal Business Name): IYANA EMGRAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 ELLIS ST
NEW BRITAIN CT
06051-3422
US

IV. Provider business mailing address

13 ELLIS ST
NEW BRITAIN CT
06051-3422
US

V. Phone/Fax

Practice location:
  • Phone: 860-900-9978
  • Fax:
Mailing address:
  • Phone: 860-900-9978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number239177282
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: