Healthcare Provider Details

I. General information

NPI: 1427592070
Provider Name (Legal Business Name): STATE OF CONNECTICUT DEPARTMENT OF CORRECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 WOLCOTT HILL RD
WETHERSFIELD CT
06109-1152
US

IV. Provider business mailing address

24 WOLCOTT HILL RD
WETHERSFIELD CT
06109-1152
US

V. Phone/Fax

Practice location:
  • Phone: 860-692-6800
  • Fax:
Mailing address:
  • Phone: 860-692-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. KATHLEEN MAURER
Title or Position: DIRECTOR, HEALTH SERVICES
Credential: M.D.
Phone: 860-692-6888