Healthcare Provider Details

I. General information

NPI: 1447265376
Provider Name (Legal Business Name): BETH ANN J PODSOBINSKI APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 JEFFERSON ST NEW LONDON HIGH SCHOOL-BASED HEALTH CENTER
NEW LONDON CT
06320
US

IV. Provider business mailing address

34 THIRD AVE
WATERFORD CT
06385
US

V. Phone/Fax

Practice location:
  • Phone: 860-701-3771
  • Fax: 860-701-3771
Mailing address:
  • Phone: 860-437-0446
  • Fax: 860-701-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberTP003699N
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number001412
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number001412
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: