Healthcare Provider Details

I. General information

NPI: 1639949498
Provider Name (Legal Business Name): MONI PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 S MAIN ST
COLCHESTER CT
06415-1405
US

IV. Provider business mailing address

2389 MAIN ST STE 100
GLASTONBURY CT
06033-4617
US

V. Phone/Fax

Practice location:
  • Phone: 860-655-1349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: YACIHUILCA MONI
Title or Position: OWNER/PSYCHOLOGIST
Credential: PSY.D.
Phone: 860-384-7627