Provider Demographics
NPI:1710510680
Name:THE GAETANI CENTER
Entity Type:Organization
Organization Name:THE GAETANI CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:PELUSO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-707-3331
Mailing Address - Street 1:71 BRADLEY RD UNIT 6
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2662
Mailing Address - Country:US
Mailing Address - Phone:860-707-3331
Mailing Address - Fax:
Practice Address - Street 1:71 BRADLEY RD UNIT 6
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2662
Practice Address - Country:US
Practice Address - Phone:860-707-3331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty