Provider Demographics
NPI:1326371253
Name:CONNECTICUT HOLISTIC AND INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:CONNECTICUT HOLISTIC AND INTEGRATIVE MEDICINE
Other - Org Name:CHAIM
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-445-2130
Mailing Address - Street 1:1057 POQUONNOCK ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6630
Mailing Address - Country:US
Mailing Address - Phone:860-445-2130
Mailing Address - Fax:860-446-0883
Practice Address - Street 1:1057 POQUONNOCK ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6630
Practice Address - Country:US
Practice Address - Phone:860-445-2130
Practice Address - Fax:860-446-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031252207R00000X
CTAPRN000126363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty