Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 12.009932 | CT |
NPI | 1023627726 |
---|---|
Provider Name | Courtney Streeto |
First Address | Branford, CT 06405-2941 |
Second Address | Branford, CT 06405-2941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2020 |
Last Update Date | 07/10/2021 |