Provider Demographics
NPI:1437868064
Name:MCINTOSH, TRICIA N
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:N
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 NEW PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1352
Mailing Address - Country:US
Mailing Address - Phone:860-816-0377
Mailing Address - Fax:855-535-5241
Practice Address - Street 1:528 NEW PARK AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-1352
Practice Address - Country:US
Practice Address - Phone:860-816-0377
Practice Address - Fax:855-535-5241
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
CT000077172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator