Provider Demographics
NPI:1912665050
Name:VANASSE, KELLY PATRICIA (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:PATRICIA
Last Name:VANASSE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1403
Mailing Address - Country:US
Mailing Address - Phone:203-584-1463
Mailing Address - Fax:
Practice Address - Street 1:270 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1403
Practice Address - Country:US
Practice Address - Phone:860-861-5107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT121379363LP0808X
CT10297363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health