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NPI Code Detail

MEDICARE: DR. DWAIN CLARK FEHON PSY.D.

MEDICARE: DR. DWAIN CLARK FEHON PSY.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
1103TC0700XClinical Psychologist001906CT

General Provider Information

NPI Number : 1528172269
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DWAIN CLARK FEHON PSY.D.
Provider Business Mailing Address
First Line : 184 LIBERTY ST
Second Line : YALE-NEW HAVEN PSYCHIATRIC HOSPITAL
City : NEW HAVEN
State : CT
Zip : 06519-1625
Country : US
Telephone Number : 203-688-9779
Fax Number : 203-688-9709
Provider Business Practice Location Address
First Line : 184 LIBERTY ST
Second Line : YALE-NEW HAVEN PSYCHIATRIC HOSPITAL
City : NEW HAVEN
State : CT
Zip : 06519-1625
Country : US
Telephone Number : 203-688-9779
Fax Number : 203-688-9709
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2006
Last Update Date : 07/08/2007

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