MEDICARE: S COLWELL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center	002422	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1285650622	OTHER		NPI

General Provider Information

NPI Number	:	1295041739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S COLWELL, LLC

Provider Business Mailing Address
First Line	:	34 SPRUCE HILL RD
Second Line	:
City	:	SHELTON
State	:	CT
Zip	:	06484-1965
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	999 ORONOQUE LN
Second Line	:	2ND FLOOR NORTH
City	:	STRATFORD
State	:	CT
Zip	:	06614-1379
Country	:	US
Telephone Number	:	203-257-5928
Fax Number	:

Authorized Official
Title or Position	:	APRN
Name	:	MS. SHARON COLWELL
Credential	:
Telephone Number	:	203-257-5928

Provider Enumeration Date	:	08/22/2010
Last Update Date	:	08/22/2010

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Directions to “S COLWELL, LLC ” Practice Location

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