Provider Demographics
NPI:1760466957
Name:CAMIZZI, KATHRYN (APRN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:CAMIZZI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 GEORGE STREET
Mailing Address - Street 2:6TH FLOOR PO BOX 9805
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06536-0805
Mailing Address - Country:US
Mailing Address - Phone:203-785-7998
Mailing Address - Fax:203-785-6414
Practice Address - Street 1:800 HOWARD AVENUE
Practice Address - Street 2:YALE PHYSICIANS BUILDING
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-785-2140
Practice Address - Fax:203-785-6414
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001265364SP0809X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004193330Medicaid
S63775Medicare UPIN
CT004193330Medicaid