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General NPI Number Information
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NPI Number | 1043978968
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Entity Type | Organization
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Legal Business Name | TALLAWAH MENTAL HEALTH ASSOCIATES PLLC
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Dates
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Enumeration Date | 12/08/2021
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 701 COTTAGE GROVE RD STE D235
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City | BLOOMFIELD
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State | CT
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Zip | 06002-3080
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Country | US
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Telephone | 860-578-8013
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Fax |
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Provider Business Mailing Address
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Address Line | 701 COTTAGE GROVE RD
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City | BLOOMFIELD
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State | CT
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Zip | 06002-3080
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Country | US
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Telephone | 860-216-2007
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ZOEY KAMARA WALKER
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Credential | APRN
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Telephone | 860-578-8013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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