Healthcare Provider Details

I. General information

NPI: 1962418772
Provider Name (Legal Business Name): SHERRI LYNN OWITZ PSY D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 MAIN STREET STE 203
GLASTONBURY CT
06033-3110
US

IV. Provider business mailing address

1420 MAIN STREET STE 203
GLASTONBURY CT
06033-3110
US

V. Phone/Fax

Practice location:
  • Phone: 860-659-3244
  • Fax:
Mailing address:
  • Phone: 860-659-3244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number001806
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: