| Organization Name: | UNIVERSITY OF CONNECTICUT STUDENT HEALTH SERVICES |
| NPI Number: | 1629097043 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TRESCA SMITH (UNIVERSITY PRIVACY/HIPAA OFFICER) |
| Mailing Address: | 234 Glenbrook Rd, Unit 4011 Student Health Services Storrs Mansfield |
| State: | CT US |
| Postal Code: | 062694011 |
| Phone Number: | 8604864456 |
| Fax Number: | 8604860004 |
| NPI Enumeration Date: | 07/18/2006 |
| NPI Last Update Date: | 08/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QS1000X |
| License Number: | 0051 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Student Health |
| Taxonomy Definition: | |