Provider Demographics
NPI:1043303258
Name:WORMSER, ELLEN J (CNM LNM)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:J
Last Name:WORMSER
Suffix:
Gender:F
Credentials:CNM LNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 BEDFORD AVENUE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517
Mailing Address - Country:US
Mailing Address - Phone:203-281-1345
Mailing Address - Fax:
Practice Address - Street 1:374 GRAND AVENUE
Practice Address - Street 2:FAIR HAVEN COMMUNITY HEALTH CTR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513
Practice Address - Country:US
Practice Address - Phone:203-777-7411
Practice Address - Fax:203-777-8506
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000054367A00000X
176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000549734OtherCT CARE
183840OtherPREFERRED ONE
400000054CT01OtherANTHEM BCBS
P523092OtherOXFORD
183840OtherPREFERRED ONE