Provider Demographics
NPI:1609373588
Name:SACRED HEART UNIVERSITY
Entity Type:Organization
Organization Name:SACRED HEART UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/CLINICAL ASSISTANT PROF
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAROTTO
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:203-644-2865
Mailing Address - Street 1:5151 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1090
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4000 PARK AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-1047
Practice Address - Country:US
Practice Address - Phone:203-396-6895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT552231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty