Basic Information
| Provider Information | |||||||||
| NPI: | 1073947065 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YALE NEW HAVEN HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 809 RACEBROOK RD | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064771232 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1450 CHAPEL ST | ||||||||
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| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065114405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037893000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2013 | ||||||||
| LastUpdateDate: | 08/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | CELENTANO | ||||||||
| AuthorizedOfficialFirstName: | JERILYN | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHIATRIC SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 2037894040 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | 008236 | CT | Y | Hospitals | Psychiatric Hospital |
No ID Information.