Provider Demographics
NPI:1760582423
Name:BATTILOCCHI, MARY (ND)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:BATTILOCCHI
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MACARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-3226
Mailing Address - Country:US
Mailing Address - Phone:203-301-0520
Mailing Address - Fax:
Practice Address - Street 1:2068 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4634
Practice Address - Country:US
Practice Address - Phone:203-301-0520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000149CT175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110000149CT01Medicaid
CTP414350OtherOXFORD
CT715646OtherCONNECTICARE
CT80705OtherGREAT WEST
CT110000149CT01OtherANTHEM BC/BS