Provider Demographics
NPI:1538458310
Name:PEDIATRIC PARENTING, LLC
Entity type:Organization
Organization Name:PEDIATRIC PARENTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CLC
Authorized Official - Phone:203-415-2238
Mailing Address - Street 1:435 AMITY RD
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3038
Mailing Address - Country:US
Mailing Address - Phone:203-415-2238
Mailing Address - Fax:
Practice Address - Street 1:435 AMITY RD
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:CT
Practice Address - Zip Code:06524-3038
Practice Address - Country:US
Practice Address - Phone:203-415-2238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000590363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP33633Medicare UPIN