Provider Demographics
NPI:1952380842
Name:PEARSON, GERALDINE S
Entity Type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:S
Last Name:PEARSON
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 1:342 HIDDEN LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:HIGGANUM
Mailing Address - State:CT
Mailing Address - Zip Code:06441
Mailing Address - Country:US
Mailing Address - Phone:860-301-0120
Mailing Address - Fax:860-679-4531
Practice Address - Street 1:65 KANE ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-2110
Practice Address - Country:US
Practice Address - Phone:860-523-3745
Practice Address - Fax:860-523-6736
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002804363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTR34692OtherREGISTERED NURSE
CT002804OtherAPRN LICENSE
CT004236015Medicaid
CT1952380842OtherMEDICAID # FOR UMG
CT004236015Medicaid
Q27280Medicare UPIN