Provider Demographics
NPI:1386145738
Name:CAISSE, EMMALEE MONICA
Entity type:Individual
Prefix:
First Name:EMMALEE
Middle Name:MONICA
Last Name:CAISSE
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 1:18 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:TERRYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06786-4721
Mailing Address - Country:US
Mailing Address - Phone:860-940-1319
Mailing Address - Fax:
Practice Address - Street 1:501 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1330
Practice Address - Country:US
Practice Address - Phone:203-392-7278
Practice Address - Fax:251-224-0570
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT97017853004OtherCONNECTICARE