Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 3587 | CT |
NPI | 1003359860 |
---|---|
Provider Name | Kaylie Phelps |
First Address | New Haven, CT 06519-1233 |
Second Address | New Haven, CT 06511-3933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2016 |
Last Update Date | 20/06/2019 |