Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 000480 | CT |
NPI | 1003184565 |
---|---|
Provider Name | Martha Wright |
First Address | New Haven, CT 06511-5991 |
Second Address | North Haven, CT 06473-3108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2011 |
Last Update Date | 06/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008038050 | (05) | CT |