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General NPI Number Information
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NPI Number | 1235404385
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Entity Type | Organization
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Legal Business Name | UCONN HEALTH CENTER
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Dates
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Enumeration Date | 03/21/2012
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Last Update Date | 03/21/2012
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Provider Practice Location Address
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Address Line | 263 FARMINGTON AVE # MC2103 ROOM # C1357
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City | FARMINGTON
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State | CT
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Zip | 06030-2103
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Country | US
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Telephone | 860-480-6501
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Fax | 860-679-4077
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Provider Business Mailing Address
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Address Line | 263 FARMINGTON AVE # MC2103 ROOM # C1357
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City | FARMINGTON
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State | CT
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Zip | 06030-2103
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Country | US
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Telephone | 860-480-6501
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Fax | 860-679-4077
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Authorized Official
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Title or Position | DIRECTOR OF HOMECARE PROGRAM
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Name | DR. GERALDINE S PEARSON
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Credential | PH.D.
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Telephone | 18606794089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 004916
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License Number State | CT
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