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General NPI Number Information
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NPI Number | 1477926459
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Entity Type | Organization
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Legal Business Name | CORE PRINCIPLES
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Dates
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Enumeration Date | 11/12/2015
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Last Update Date | 11/12/2015
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Provider Practice Location Address
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Address Line | 98 MAIN ST
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City | SOUTHINGTON
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State | CT
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Zip | 06489-2500
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Country | US
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Telephone | 860-604-6068
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Fax |
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Provider Business Mailing Address
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Address Line | 98 MAIN ST
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City | SOUTHINGTON
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State | CT
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Zip | 06489-2500
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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 | OWNER
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Name | MARISA FORTI
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Credential | LMT
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Telephone | 860-604-6068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 6813
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License Number State | CT
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