Individual
MRS. JENNY M BRADDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, OCS
Contact information
Practice address
117 SHARON RD, MALL VIEW PLAZA, WATERBURY, CT 06705-4000
(203) 756-2334
(203) 756-2594
Mailing address
247 HILL RD, HARWINTON, CT 06791-2502
(860) 485-0755
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
007053
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080007053CT01
BCBS PROVIDER NUMBER
CT
Enumeration date
11/06/2006
Last updated
07/09/2007
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