Healthcare Provider Details

I. General information

NPI: 1114074606
Provider Name (Legal Business Name): TOWN OF STRATFORD HEALTH DEPT.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 LINCOLN ST
STRATFORD CT
06614-4000
US

IV. Provider business mailing address

150 LINCOLN ST
STRATFORD CT
06614-4000
US

V. Phone/Fax

Practice location:
  • Phone: 203-381-6922
  • Fax: 203-381-6923
Mailing address:
  • Phone: 203-381-6922
  • Fax: 203-381-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number0252
License Number StateCT

VIII. Authorized Official

Name: GRETA BRONEILL
Title or Position: PROJECT COORDINATOR
Credential: MPH
Phone: 203-381-6922