Healthcare Provider Details

I. General information

NPI: 1669830139
Provider Name (Legal Business Name): MICHELLE DARA WIDDOWS PMHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE KAPLIN RN

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 TECHNOLOGY DR FL 2
TRUMBULL CT
06611-6348
US

IV. Provider business mailing address

105 TECHNOLOGY DR FL 2
TRUMBULL CT
06611-6348
US

V. Phone/Fax

Practice location:
  • Phone: 475-228-0961
  • Fax: 203-283-6490
Mailing address:
  • Phone: 475-228-0961
  • Fax: 203-283-6490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12.014410
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number606396
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10.146391
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: