Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 000788 | CT |
Y | 225XM0800X | Mental Health | 000788 | CT |
NPI | 1770922197 |
---|---|
Provider Name | Elizabeth Sullivan-Well |
First Address | Waterbury, CT 06708-1917 |
Second Address | Waterbury, CT 06710-2202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2013 |
Last Update Date | 25/06/2013 |