Healthcare Provider Details

I. General information

NPI: 1578052114
Provider Name (Legal Business Name): CARA LATTIZORI NGUYEN, PSY.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 RIVER RD STE A
COLLINSVILLE CT
06019-3245
US

IV. Provider business mailing address

PO BOX 735
NEW HARTFORD CT
06057-0735
US

V. Phone/Fax

Practice location:
  • Phone: 860-307-0379
  • Fax:
Mailing address:
  • Phone: 860-307-0379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number002940
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. CARA SIENA NGUYEN
Title or Position: MEMBER
Credential: PSY.D.
Phone: 860-307-0379