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General NPI Number Information
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NPI Number | 1295041739
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Entity Type | Organization
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Legal Business Name | S COLWELL, LLC
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Dates
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Enumeration Date | 08/22/2010
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Last Update Date | 08/22/2010
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Provider Practice Location Address
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Address Line | 999 ORONOQUE LN 2ND FLOOR NORTH
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City | STRATFORD
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State | CT
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Zip | 06614-1379
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Country | US
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Telephone | 203-257-5928
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Fax |
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Provider Business Mailing Address
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Address Line | 34 SPRUCE HILL RD
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City | SHELTON
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State | CT
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Zip | 06484-1965
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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 | APRN
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Name | MS. SHARON COLWELL
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Credential |
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Telephone | 203-257-5928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 002422
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License Number State | CT
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