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General NPI Number Information
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NPI Number | 1336518034
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Entity Type | Organization
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Legal Business Name | NEW HAVEN PUBLIC SCHOOLS
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Dates
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Enumeration Date | 09/23/2015
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Last Update Date | 09/23/2015
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Provider Practice Location Address
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Address Line | 170 DERBY AVE
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City | NEW HAVEN
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State | CT
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Zip | 06511-5144
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Country | US
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Telephone | 203-946-4860
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Fax |
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Provider Business Mailing Address
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Address Line | 54 MEADOW ST 3RD FLOOR
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City | NEW HAVEN
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State | CT
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Zip | 06519-1783
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Country | US
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Telephone | 203-946-4860
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Fax |
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Authorized Official
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Title or Position | DIRECTOR SCHOOL HEALTH CENTERS
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Name | SUSAN PETERS
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Credential | APRN
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Telephone | 203-946-4860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 0755
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License Number State | CT
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