Healthcare Provider Details

I. General information

NPI: 1386091692
Provider Name (Legal Business Name): ALESHA WELLS BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PUTNAM ROAD
WAUREGAN CT
06387-0378
US

IV. Provider business mailing address

303 PUTNAM ROAD
WAUREGAN CT
06387-0378
US

V. Phone/Fax

Practice location:
  • Phone: 860-564-6100
  • Fax: 860-564-6110
Mailing address:
  • Phone: 860-564-6100
  • Fax: 860-564-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: