Individual
MS. VIRGINIA TAVERNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
54 E RAMSDELL ST, NEW HAVEN, CT 06515-1140
(203) 337-9943
(203) 387-6533
Mailing address
1 LONG WHARF DR, NEW HAVEN, CT 06511-5991
(203) 781-4600
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000988
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008023170
—
CT
05
—
008024427
—
CT
05
—
008039745
—
CT
01
—
008045348
TAVERNER MEDICAID
—
Enumeration date
06/10/2013
Last updated
10/02/2017
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