Healthcare Provider Details

I. General information

NPI: 1497298848
Provider Name (Legal Business Name): MS. AMY EILEEN YAZMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2016
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 JOHN DOWNEY DRIVE
NEW BRITIAN CT
06051
US

IV. Provider business mailing address

270 JOHN DOWNEY DRIVE
NEW BRITIAN CT
06051
US

V. Phone/Fax

Practice location:
  • Phone: 860-826-1358
  • Fax: 860-224-6516
Mailing address:
  • Phone: 860-826-1358
  • Fax: 860-224-6516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number001147
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: