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General NPI Number Information
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NPI Number | 1720128853
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Entity Type | Organization
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Legal Business Name | NICOLA CLARKE
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 27 AMBER PL
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City | WATERBURY
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State | CT
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Zip | 06705-1240
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Country | US
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Telephone | 203-568-0529
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Fax |
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Provider Business Mailing Address
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Address Line | 27 AMBER PLACE
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City | WATERBURY
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State | CT
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Zip | 06705
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Country | US
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Telephone | 203-568-0529
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Fax |
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Authorized Official
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Title or Position | RN
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Name | MISS NICOLA CLARKE
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Credential |
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Telephone | 203-568-0529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 078870
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License Number State | CT
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