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Individual
LAURA GAULT
Active
Individual
LAURA GAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
040626
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040626
STATE OF CT LIC
CT
01
—
34027
ST CONTROL DRUG REG.
CT
01
—
BG8519487
D.E.A. REG. #
CT
Enumeration date
08/08/2006
Last updated
07/08/2007
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