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General NPI Number Information
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NPI Number | 1396244398
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Entity Type | Organization
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Legal Business Name | CONNECTICUT BRANCHES
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Dates
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Enumeration Date | 02/05/2018
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Last Update Date | 02/05/2018
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Provider Practice Location Address
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Address Line | 30 HAZEL TER STE 2
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City | WOODBRIDGE
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State | CT
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Zip | 06525-2240
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Country | US
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Telephone | 203-987-3968
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Fax | 203-987-6313
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Provider Business Mailing Address
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Address Line | PO BOX 3824
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City | WOODBRIDGE
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State | CT
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Zip | 06525-0824
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Country | US
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Telephone | 203-987-3968
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Fax | 203-987-6313
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Authorized Official
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Title or Position | OWNER
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Name | JODIE SIMPSON
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Credential | MS
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Telephone | 203-987-3968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State | CT
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