Provider Demographics
NPI:1780784959
Name:MUNSON-BETTE, MAUREEN
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:
Last Name:MUNSON-BETTE
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 1:264 MAIN ST S STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-3407
Mailing Address - Country:US
Mailing Address - Phone:203-263-0002
Mailing Address - Fax:023-263-0090
Practice Address - Street 1:264 MAIN ST S STE 200
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3407
Practice Address - Country:US
Practice Address - Phone:203-263-0002
Practice Address - Fax:203-263-0090
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6697775OtherGHI
CT08000168CT07OtherBCBS
CT7467OtherEMPIRE PPO
CTP2775789OtherOXFORD
CT630019OtherCONNECTICARE
CT2V6534OtherHEALTHNET
CT44101OtherCIGNA
CT7871305OtherAETNA