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General NPI Number Information
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NPI Number | 1740738749
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Entity Type | Individual
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Provider Name | MISS CLAIRENETTE WILLIAMS I
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Gender | Female
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 09/19/2016
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Provider Practice Location Address
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Address Line | 142 CEDAR HILL AVE UNIT 2L
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City | NEW HAVEN
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State | CT
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Zip | 06511-2708
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Country | US
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Telephone | 203-745-1863
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Fax | 203-498-7670
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Provider Business Mailing Address
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Address Line | 142 CEDAR HILL AVE UNIT 2L
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City | NEW HAVEN
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State | CT
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Zip | 06511-2708
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Country | US
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Telephone | 203-745-1863
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Fax | 203-498-7670
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | HCA.0001178
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License Number State | CT
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