Healthcare Provider Details

I. General information

NPI: 1073947065
Provider Name (Legal Business Name): YALE NEW HAVEN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CHAPEL ST
NEW HAVEN CT
06511-4405
US

IV. Provider business mailing address

809 RACEBROOK RD
ORANGE CT
06477-1232
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number008236
License Number StateCT

VIII. Authorized Official

Name: MRS. JERILYN B CELENTANO
Title or Position: PSYCHIATRIC SOCIAL WORKER
Credential: LCSW
Phone: 203-789-4040