Healthcare Provider Details

I. General information

NPI: 1386853182
Provider Name (Legal Business Name): TOWN OF STRATFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 BIRDSEYE ST 3RD FLOOR
STRATFORD CT
06615-6976
US

IV. Provider business mailing address

468 BIRDSEYE ST 3RD FLOOR
STRATFORD CT
06615-6976
US

V. Phone/Fax

Practice location:
  • Phone: 203-385-4090
  • Fax: 203-381-2048
Mailing address:
  • Phone: 203-385-4090
  • Fax: 203-381-2048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ANDREA BOISSEVAIN
Title or Position: HEALTH DIRECTOR
Credential: MPH
Phone: 203-385-4090