Provider Demographics
NPI:1760209746
Name:PENTELL, ISABEL Q (LADC)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:Q
Last Name:PENTELL
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 GOLD STAR HWY
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-2739
Mailing Address - Country:US
Mailing Address - Phone:860-629-8270
Mailing Address - Fax:860-445-0414
Practice Address - Street 1:1353 GOLD STAR HWY
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-2739
Practice Address - Country:US
Practice Address - Phone:860-629-8270
Practice Address - Fax:860-445-0414
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00752101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)