MEDICARE: DR. PARASTOO PAMELA GHAZI PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810005089	VA
2	103TC0700X	Clinical Psychologist	003769	CT

General Provider Information

NPI Number	:	1295138717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PARASTOO PAMELA GHAZI PH.D.

Provider Business Mailing Address
First Line	:	37 WINDING TRL
Second Line	:
City	:	CHESHIRE
State	:	CT
Zip	:	06410-3324
Country	:	US
Telephone Number	:	703-203-7878
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 TRUMBULL ST # 112
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-6312
Country	:	US
Telephone Number	:	860-980-0813
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2014
Last Update Date	:	10/11/2018

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