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General NPI Number Information
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NPI Number | 1083863922
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Entity Type | Organization
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Legal Business Name | UNITED SERVICES
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 09/16/2008
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Provider Practice Location Address
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Address Line | 1007 N MAIN ST
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City | DAYVILLE
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State | CT
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Zip | 06241-2170
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Country | US
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Telephone | 860-456-2261
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Fax |
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Provider Business Mailing Address
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Address Line | 1007 N MAIN ST
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City | DAYVILLE
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State | CT
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Zip | 06241-2170
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | TERA JUSZCZYK
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Credential | MSW
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Telephone | 860-456-2261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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