Healthcare Provider Details

I. General information

NPI: 1083927164
Provider Name (Legal Business Name): VISITING NURSE ASSOCIATION OF WALLINGFORD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N PLAINS INDUSTRIAL RD
WALLINGFORD CT
06492-2332
US

IV. Provider business mailing address

135 N PLAINS INDUSTRIAL RD
WALLINGFORD CT
06492-2332
US

V. Phone/Fax

Practice location:
  • Phone: 203-269-1475
  • Fax: 203-265-5357
Mailing address:
  • Phone: 203-269-1475
  • Fax: 203-265-5357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateCT

VIII. Authorized Official

Name: MS. ELLEN S. PHILLIPS
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 203-269-1475