MEDICARE: PSYCHOLOGICAL HEALTH ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	103TC2200X	Clinical Child & Adolescent Psychologist
3	103T00000X	Psychologist
4	103TP2701X	Group Psychotherapy Psychologist
5	1041C0700X	Clinical Social Worker
6	106H00000X	Marriage & Family Therapist
7	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1508899212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHOLOGICAL HEALTH ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	701 COTTAGE GROVE RD STE C210
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-4207
Country	:	US
Telephone Number	:	860-233-9772
Fax Number	:	860-236-9402

Provider Business Practice Location Address
First Line	:	701 COTTAGE GROVE RD STE 302
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3080
Country	:	US
Telephone Number	:	860-233-9772
Fax Number	:	860-236-9402

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	DR. MARCI B. KORWIN
Credential	:	PHD
Telephone Number	:	860-233-9772

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	08/25/2020

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