Healthcare Provider Details

I. General information

NPI: 1780682633
Provider Name (Legal Business Name): RONALD KADDEN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 TALCOTT NOTCH
FARMINGTON CT
06030-0001
US

IV. Provider business mailing address

263 FARMINGTON AVE PROVIDER ENROLLMENT
FARMINGTON CT
06030-2212
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-6700
  • Fax: 860-679-6736
Mailing address:
  • Phone: 860-679-7503
  • Fax: 860-679-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number000826
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: