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General NPI Number Information
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NPI Number | 1013027754
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Entity Type | Organization
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Legal Business Name | ST OF CT DEPT. OF PUBLIC HEALTH LABORATORY
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10 CLINTON ST
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City | HARTFORD
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State | CT
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Zip | 06106-1624
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Country | US
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Telephone | 860-509-8500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1689
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City | HARTFORD
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State | CT
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Zip | 06144-1689
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Country | US
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Telephone | 860-509-8500
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Fax | 860-509-8697
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | DR. KATHERINE KELLEY
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Credential |
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Telephone | 860-509-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CL-0197
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License Number State | CT
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