Provider Demographics
NPI:1699914903
Name:NELSON, TAMMY CHRISTINE (MS)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:CHRISTINE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 DANBURY RD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4029
Mailing Address - Country:US
Mailing Address - Phone:203-438-3007
Mailing Address - Fax:203-894-1388
Practice Address - Street 1:77 DANBURY RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4029
Practice Address - Country:US
Practice Address - Phone:203-438-3007
Practice Address - Fax:203-894-1388
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000234101YA0400X
CT001002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)