Healthcare Provider Details

I. General information

NPI: 1336581800
Provider Name (Legal Business Name): MICHEL JEAN-BAPTISTE, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 AMITY RD SUITE 132
WOODBRIDGE CT
06525-2236
US

IV. Provider business mailing address

270 AMITY RD SUITE 132
WOODBRIDGE CT
06525-2236
US

V. Phone/Fax

Practice location:
  • Phone: 203-397-5491
  • Fax: 203-397-3537
Mailing address:
  • Phone: 203-397-5491
  • Fax: 203-397-3537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHEL JEAN-BAPTISTE
Title or Position: PRESIDENT
Credential: MD
Phone: 203-397-5491