Individual
MRS. MADELINE FRANCIS REVERE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
64 ROBBINS ST, CRISIS INTERVENTION CENTER, WATERBURY, CT 06708-2613
(203) 573-6798
(203) 573-7007
Mailing address
3 SABBADAY LN, WASHINGTON, CT 06793-1306
(860) 868-0440
(203) 573-7007
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
000241
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
890000386
MEDICARE ID- TYPE UNSPECIFIED
CT
Enumeration date
11/18/2005
Last updated
04/08/2011
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