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General NPI Number Information
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NPI Number | 1386314888
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Entity Type | Organization
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Legal Business Name | WOMEN FAMILY HEALTH & WELLNESS LLC
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Dates
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Enumeration Date | 09/15/2021
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 10 JUNIPER DR
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City | NORTH HAVEN
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State | CT
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Zip | 06473-3509
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Country | US
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Telephone | 203-500-6152
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 211
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City | NORTH HAVEN
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State | CT
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Zip | 06473-0211
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Country | US
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Telephone | 203-500-6152
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SURSATIE CHETRAM
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Credential | PHD
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Telephone | 203-500-6152
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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 |
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License Number State |
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