Individual
SHAWN BAZEMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
141 E MAIN ST, WATERBURY, CT 06702-2310
(203) 575-0641
Mailing address
141 E MAIN ST, WATERBURY, CT 06702-2310
(203) 575-0641
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
06/27/2012
Last updated
06/27/2012
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