Provider Demographics
NPI:1861487852
Name:DREYFUS, JOAN K (APRN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:K
Last Name:DREYFUS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1890 DIXWELL AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-3122
Mailing Address - Country:US
Mailing Address - Phone:203-404-6444
Mailing Address - Fax:203-407-6442
Practice Address - Street 1:60 WASHINGTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3271
Practice Address - Country:US
Practice Address - Phone:203-407-6400
Practice Address - Fax:203-281-5555
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2012-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT000931163WP0809X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COS55841Medicare UPIN
CT890000108Medicare ID - Type Unspecified