Healthcare Provider Details

I. General information

NPI: 1487765905
Provider Name (Legal Business Name): MARTHA PORTER HAESELER ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CAMPBELL AVE 124
WEST HAVEN CT
06516-2770
US

IV. Provider business mailing address

62 HILLTOP RD
GUILFORD CT
06437-3221
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-5711
  • Fax: 203-937-4791
Mailing address:
  • Phone: 203-453-6468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: