Individual
MS. STACY AILEEN CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
45 WADSWORTH ST, HARTFORD, CT 06106-7108
(860) 680-5096
Mailing address
101 WALKER ST, MANCHESTER, CT 06040-4339
(860) 680-5096
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/19/2022
Last updated
10/19/2022
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