Healthcare Provider Details

I. General information

NPI: 1801003900
Provider Name (Legal Business Name): JUNE FEOLA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MID-FAIRFIELD CHILD GUIDANCE CENTER 100 EAST AVENUE
NORWALK CT
06851
US

IV. Provider business mailing address

MID-FAIRFIELD CHILD GUIDANCE CENTER 100 EAST AVENUE
NORWALK CT
06851
US

V. Phone/Fax

Practice location:
  • Phone: 203-299-1315
  • Fax:
Mailing address:
  • Phone: 203-299-1315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number001655
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: