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NPI Code Detail

MEDICARE: MIRANDA M DUPONT CLINICAL COORDINATOR

MEDICARE: MIRANDA M DUPONT CLINICAL COORDINATOR
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1538595269
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRANDA M DUPONT CLINICAL COORDINATOR
Provider Business Mailing Address
First Line : 22 CHASE RIVER RD
Second Line :
City : WATERBURY
State : CT
Zip : 06704-1408
Country : US
Telephone Number : 203-753-2153
Fax Number :
Provider Business Practice Location Address
First Line : 22 CHASE RIVER RD
Second Line :
City : WATERBURY
State : CT
Zip : 06704-1408
Country : US
Telephone Number : 203-753-2153
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2013
Last Update Date : 09/26/2013

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