Healthcare Provider Details

I. General information

NPI: 1770802886
Provider Name (Legal Business Name): PSYCHOLOGICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 08/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 NORTH AVE
BRIDGEPORT CT
06604-2438
US

IV. Provider business mailing address

2157 NORTH AVE
BRIDGEPORT CT
06604-2438
US

V. Phone/Fax

Practice location:
  • Phone: 203-335-0345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MATEFY
Title or Position: OWNER
Credential: PH.D.
Phone: 203-335-0345