Most Relevant Information
Provider Data
| NPI Number: | 1003248915 |
| Provider Name: | DANIELLE DAVENPORT BA |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/01/2013 |
| Last Updated: | 08/01/2013 |
Provider Practice Location
141 E MAIN ST
WATERBURY
CT
067022310
Practice Location Phone/Fax
| Phone: | 2035749000 |
| Fax: | 2035749006 |
Provider Mailing Location
141 E MAIN ST
WATERBURY
CT
067022310
Provider Mailing Phone/Fax
| Phone: | 2035749000 |
| Fax: | 2035749006 |