Healthcare Provider Details

I. General information

NPI: 1164505996
Provider Name (Legal Business Name): YALE NEW HAVEN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 LIBERTY ST
NEW HAVEN CT
06519-1625
US

IV. Provider business mailing address

20 YORK STREET YALE NEW HAVEN HOSPITAL
NEW HAVEN CT
06510
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-9801
  • Fax: 203-688-9860
Mailing address:
  • Phone: 203-688-9801
  • Fax: 203-688-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number001353
License Number StateCT

VIII. Authorized Official

Name: MR. CHARLES - PEARSON
Title or Position: SERVICE MANAGER
Credential: LCSW
Phone: 203-688-9820