Healthcare Provider Details

I. General information

NPI: 1841552049
Provider Name (Legal Business Name): ELAINE SOTO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 GRANT ST
NEW HAVEN CT
06519-2514
US

IV. Provider business mailing address

62 GRANT ST
NEW HAVEN CT
06519-2514
US

V. Phone/Fax

Practice location:
  • Phone: 203-503-3350
  • Fax: 203-503-3370
Mailing address:
  • Phone: 203-503-3350
  • Fax: 203-503-3370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1134
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: