Provider Demographics
NPI:1871796383
Name:YALE UNIV SCHOOL OF MEDICINE
Entity type:Organization
Organization Name:YALE UNIV SCHOOL OF MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE CHAIRMAN FOR CLINICAL AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-785-4216
Mailing Address - Street 1:230 SOUTH FRONTAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-0309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 SOUTH FRONTAGE ROAD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-0309
Practice Address - Country:US
Practice Address - Phone:203-785-4216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTOTH000Medicare UPIN