Healthcare Provider Details

I. General information

NPI: 1679108534
Provider Name (Legal Business Name): ALMA BARRETO APRN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CASE ST STE 202
NORWICH CT
06360-2222
US

IV. Provider business mailing address

6 DENNIS DR
UNCASVILLE CT
06382-4002
US

V. Phone/Fax

Practice location:
  • Phone: 860-823-9236
  • Fax:
Mailing address:
  • Phone: 860-823-9236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALMA R BARRETO
Title or Position: AUTHORIZED OFFICIAL / OWNER
Credential: APRN
Phone: 860-823-9236