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General NPI Number Information
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NPI Number | 1992057772
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Entity Type | Organization
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Legal Business Name | WILLOW TREATMENT & ASSOCIATES, INC.
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Dates
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Enumeration Date | 10/04/2012
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Last Update Date | 02/05/2013
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Provider Practice Location Address
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Address Line | 60 CONNOLLY PARKWAY; BUILDING 2C-207 WILBUR CROSS COMMONS
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City | HAMDEN
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State | CT
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Zip | 06514
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Country | US
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Telephone | 203-535-0318
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Fax |
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Provider Business Mailing Address
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Address Line | 60 CONNOLLY PARKWAY; BUILDING 2C-207 WILBUR CROSS COMMONS
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City | HAMDEN
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State | CT
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Zip | 06514
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Country | US
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Telephone | 203-535-0318
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. KATHRYN CAMIZZI
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Credential | APRN
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Telephone | 203-535-0318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 001265
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 001265
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 001265
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License Number State | CT
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