Individual
LAURA GAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
342 HARBOR ST, BRANFORD, CT 06405-4540
(203) 481-4248
(203) 483-7727
Mailing address
6 WALKER ST, MILFORD, CT 06460-6551
(203) 671-1599
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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