Healthcare Provider Details

I. General information

NPI: 1245086123
Provider Name (Legal Business Name): MARIA BERNADETTE TELLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 MAIN ST
WEST HAVEN CT
06516-7307
US

IV. Provider business mailing address

97 GRASMERE AVE
FAIRFIELD CT
06824-6137
US

V. Phone/Fax

Practice location:
  • Phone: 203-503-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16723
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: