=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386853182
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOWN OF STRATFORD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2007
-----------------------------------------------------
Last Update Date | 11/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 468 BIRDSEYE ST 3RD FLOOR
-----------------------------------------------------
City | STRATFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06615-6976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-385-4090
-----------------------------------------------------
Fax | 203-381-2048
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 468 BIRDSEYE ST 3RD FLOOR
-----------------------------------------------------
City | STRATFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06615-6976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-385-4090
-----------------------------------------------------
Fax | 203-381-2048
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HEALTH DIRECTOR
-----------------------------------------------------
Name | MS. ANDREA BOISSEVAIN
-----------------------------------------------------
Credential | MPH
-----------------------------------------------------
Telephone | 203-385-4090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP0905X
-----------------------------------------------------
Taxonomy Name | State or Local Public Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------