Provider Demographics
NPI:1447265376
Name:PODSOBINSKI, BETH ANN J (APRN BC)
Entity type:Individual
Prefix:MS
First Name:BETH ANN
Middle Name:J
Last Name:PODSOBINSKI
Suffix:
Gender:F
Credentials:APRN BC
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Mailing Address - Street 1:34 THIRD AVE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385
Mailing Address - Country:US
Mailing Address - Phone:860-437-0446
Mailing Address - Fax:860-701-3776
Practice Address - Street 1:490 JEFFERSON ST
Practice Address - Street 2:NEW LONDON HIGH SCHOOL-BASED HEALTH CENTER
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-701-3771
Practice Address - Fax:860-701-3771
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PATP003699N363LP0200X
CT001412363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MP1178931OtherDEA