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General NPI Number Information
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NPI Number | 1811845746
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Entity Type | Individual
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Provider Name | MARQUASHA PETAWAY
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Gender | Female
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Dates
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Enumeration Date | 03/17/2026
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Last Update Date | 03/17/2026
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Provider Practice Location Address
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Address Line | 2666 STATE ST STE A3
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City | HAMDEN
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State | CT
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Zip | 06517-2232
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Country | US
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Telephone | 188-875-4039
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Fax |
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Provider Business Mailing Address
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Address Line | 22 CASSIUS ST
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City | NEW HAVEN
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State | CT
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Zip | 06519-2313
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Country | US
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Telephone | 917-896-0535
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Fax |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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