Healthcare Provider Details

I. General information

NPI: 1720999048
Provider Name (Legal Business Name): ISAAC HUNTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 CHIPMAN STREET EXT
WATERBURY CT
06708-3601
US

IV. Provider business mailing address

173 CHIPMAN STREET EXT
WATERBURY CT
06708-3601
US

V. Phone/Fax

Practice location:
  • Phone: 475-689-0364
  • Fax:
Mailing address:
  • Phone: 475-689-0364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number188573301
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: