Provider Demographics
NPI:1023459468
Name:YALE NEW HAVEN HOSPITAL
Entity type:Organization
Organization Name:YALE NEW HAVEN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ALCOHOL AND DRUG COUNSELOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:203-784-8704
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:203-784-8704
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:203-784-8704
Practice Address - Fax:203-784-8703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001037283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001037Medicaid