Provider Demographics
NPI:1821542408
Name:FRESH PATHWAYS
Entity Type:Organization
Organization Name:FRESH PATHWAYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYHIATRIC PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BASSETT
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:203-915-0648
Mailing Address - Street 1:80 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-1943
Mailing Address - Country:US
Mailing Address - Phone:203-915-0648
Mailing Address - Fax:
Practice Address - Street 1:57 PLAINS RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-2573
Practice Address - Country:US
Practice Address - Phone:203-915-0648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005987363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty