1285658435 NPI number — KATHRYN C P SCRIMENTI PH D

Table of content: KATHRYN C P SCRIMENTI PH D (NPI 1285658435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285658435 NPI number — KATHRYN C P SCRIMENTI PH D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCRIMENTI
Provider First Name:
KATHRYN
Provider Middle Name:
C P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285658435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2553 WHITNEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMDEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06518-3021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-640-1229
Provider Business Mailing Address Fax Number:
203-248-3339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91 POINT JUDITH RD. SUITE 26
Provider Second Line Business Practice Location Address:
UNIT 313
Provider Business Practice Location Address City Name:
NARRAGANSETT
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02882-3468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-208-9337
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PS02103 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 002596 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004246585 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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