Healthcare Provider Details

I. General information

NPI: 1821910126
Provider Name (Legal Business Name): PROF. MADELON VISINTAINER BARANOSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 PARK ST
NEW HAVEN CT
06519-1109
US

IV. Provider business mailing address

344 CURTIS ST
MERIDEN CT
06450-5952
US

V. Phone/Fax

Practice location:
  • Phone: 203-668-9366
  • Fax:
Mailing address:
  • Phone: 203-668-9366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number001167
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number001167
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: