Healthcare Provider Details

I. General information

NPI: 1871796383
Provider Name (Legal Business Name): YALE UNIV SCHOOL OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 SOUTH FRONTAGE ROAD
NEW HAVEN CT
06519-0309
US

IV. Provider business mailing address

230 SOUTH FRONTAGE ROAD
NEW HAVEN CT
06519-0309
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4216
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateCT

VIII. Authorized Official

Name: JOSEPH WOOLSTEN
Title or Position: VICE CHAIRMAN FOR CLINICAL AFFAIRS
Credential: M.D.
Phone: 203-785-4216