Healthcare Provider Details

I. General information

NPI: 1427377241
Provider Name (Legal Business Name): RALPH DODD PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RETREAT AVE HARTFORD HOSPITAL PSYCH DEPT
HARTFORD CT
06106-3309
US

IV. Provider business mailing address

200 RETREAT AVE HARTFORD HOSPITAL PSYCH DEPT
HARTFORD CT
06106-3309
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-7238
  • Fax:
Mailing address:
  • Phone: 860-545-7238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number002642
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2642
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: