Provider Demographics
NPI:1972629475
Name:GILLIS-TOFFOLO, JANET
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:
Last Name:GILLIS-TOFFOLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1294 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4515
Mailing Address - Country:US
Mailing Address - Phone:203-784-8793
Mailing Address - Fax:203-784-8703
Practice Address - Street 1:1294 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4515
Practice Address - Country:US
Practice Address - Phone:203-784-8793
Practice Address - Fax:203-784-8703
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002163363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT28985OtherCONTROLLED SUBSTANCE
CTMT0486591OtherDEA
CTMT0486591OtherDEA