Provider Demographics
NPI:1952883852
Name:BARIBAULT, CASSIE ANN (RN)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:ANN
Last Name:BARIBAULT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 FALLS AVE
Mailing Address - Street 2:
Mailing Address - City:OAKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06779-1800
Mailing Address - Country:US
Mailing Address - Phone:203-509-7336
Mailing Address - Fax:
Practice Address - Street 1:325 BOSTON POST RD STE 3E
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3504
Practice Address - Country:US
Practice Address - Phone:203-795-5425
Practice Address - Fax:203-795-5645
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT153010163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse