Provider Demographics
NPI:1629097043
Name:UNIVERSITY OF CONNECTICUT STUDENT HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:UNIVERSITY OF CONNECTICUT STUDENT HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-486-0747
Mailing Address - Street 1:234 GLENBROOK RD.
Mailing Address - Street 2:
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06269-4011
Mailing Address - Country:US
Mailing Address - Phone:860-486-4456
Mailing Address - Fax:860-486-0004
Practice Address - Street 1:234 GLENBROOK RD UNIT 4011
Practice Address - Street 2:
Practice Address - City:STORRS MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06269-4011
Practice Address - Country:US
Practice Address - Phone:860-486-4700
Practice Address - Fax:860-486-5300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF CONNECTICUT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0051261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTAU7609944OtherDEA # (RE: PRESCRIPTIONS)