Healthcare Provider Details

I. General information

NPI: 1114336955
Provider Name (Legal Business Name): PLANNED PARETHOOD OF SOUTHERN NEW ENGLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 NEW BRITAIN AVE
WEST HARTFORD CT
06110-2261
US

IV. Provider business mailing address

345 WHITNEY AVE
NEW HAVEN CT
06511-2348
US

V. Phone/Fax

Practice location:
  • Phone: 860-953-6201
  • Fax: 860-947-2309
Mailing address:
  • Phone: 203-752-2856
  • Fax: 203-852-8785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number005700
License Number StateCT

VIII. Authorized Official

Name: MRS. JUDY TABAR
Title or Position: CEO
Credential:
Phone: 203-752-2816