Healthcare Provider Details

I. General information

NPI: 1477418580
Provider Name (Legal Business Name): MS. ISABELLE AVRIDOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 112704
STAMFORD CT
06911-2704
US

IV. Provider business mailing address

PO BOX 112704
STAMFORD CT
06911-2704
US

V. Phone/Fax

Practice location:
  • Phone: 203-550-9517
  • Fax:
Mailing address:
  • Phone: 203-550-9517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1656
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: