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General NPI Number Information
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NPI Number | 1821542408
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Entity Type | Organization
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Legal Business Name | FRESH PATHWAYS
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 08/11/2016
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Provider Practice Location Address
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Address Line | 57 PLAINS RD
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City | MILFORD
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State | CT
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Zip | 06461-2573
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Country | US
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Telephone | 203-915-0648
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Fax |
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Provider Business Mailing Address
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Address Line | 80 COUNTRY LN
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City | MILFORD
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State | CT
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Zip | 06461-1943
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Country | US
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Telephone | 203-915-0648
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Fax |
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Authorized Official
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Title or Position | PSYHIATRIC PROVIDER
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Name | DR. TANYA R. BASSETT
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Credential | DNP
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Telephone | 203-915-0648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 005987
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License Number State | CT
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