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General NPI Number Information
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NPI Number | 1245520220
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Entity Type | Individual
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Provider Name | EILEEN CORREIA-DEPAOLA L.M.T
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Gender | Female
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 140 GRANDVIEW AVE SUITE 104
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City | WATERBURY
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State | CT
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Zip | 06708-2505
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Country | US
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Telephone | 860-919-4904
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Fax |
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Provider Business Mailing Address
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Address Line | 35 BALDWIN AVE
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City | WATERBURY
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State | CT
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Zip | 06706-1818
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Country | US
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Telephone | 860-919-4904
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 0006424
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 9995656
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License Number State | CT
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