Healthcare Provider Details

I. General information

NPI: 1740611748
Provider Name (Legal Business Name): ANNA GUT CNS, PMH-BC, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 WHITE PLAINS RD
TRUMBULL CT
06611-4857
US

IV. Provider business mailing address

502 WHITE PLAINS RD
TRUMBULL CT
06611-4857
US

V. Phone/Fax

Practice location:
  • Phone: 860-810-2302
  • Fax: 203-349-2087
Mailing address:
  • Phone: 860-810-2302
  • Fax: 203-349-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number001319
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number001319
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code364SP0811X
TaxonomyChronically Ill Psychiatric/Mental Health Clinical Nurse Specialist
License Number001319
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code364SP0813X
TaxonomyGeropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
License Number001319
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number001319
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: