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Behavioral Health & Social Service Providers Psychologist

Provider NPI: 1669659496

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
177 STEEP HILL RD  WESTON, CT 06883-1923 US
Tel: 203-454-9545  Fax: --

Business Mailing Address:
177 STEEP HILL RD  WESTON, CT 06883-1923 US
Tel: 203-454-9545  Fax: --

NPI Information:
NPI: 1669659496
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
N103T00000XBehavioral Health & Social Service Providers
N103TB0200XBehavioral Health & Social Service Providers
Y103TC2200XBehavioral Health & Social Service Providers
N103TS0200XBehavioral Health & Social Service Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 103TC2200X





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