Healthcare Provider Details

I. General information

NPI: 1700600723
Provider Name (Legal Business Name): BRIANA PIVARNIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRADLEY RD STE 404
WOODBRIDGE CT
06525-2235
US

IV. Provider business mailing address

2446 WHITNEY AVE FL 2
HAMDEN CT
06518-3233
US

V. Phone/Fax

Practice location:
  • Phone: 203-298-9005
  • Fax: 203-298-9453
Mailing address:
  • Phone: 203-298-9005
  • Fax: 203-643-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: