Healthcare Provider Details

I. General information

NPI: 1770926628
Provider Name (Legal Business Name): CONNECTICUT VALLEY MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 W SWANZEY RD
SWANZEY NH
03446-3222
US

IV. Provider business mailing address

907 W SWANZEY RD
SWANZEY NH
03446-3222
US

V. Phone/Fax

Practice location:
  • Phone: 603-352-5860
  • Fax:
Mailing address:
  • Phone: 603-352-5860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number107-0000007
License Number StateVT

VIII. Authorized Official

Name: MARY LAWLOR
Title or Position: OWNER
Credential: CPM
Phone: 603-352-5860