Healthcare Provider Details

I. General information

NPI: 1073671939
Provider Name (Legal Business Name): COLLEEN KELLER DREYFUS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 FRANKLIN AVE
HARTFORD CT
06114-1386
US

IV. Provider business mailing address

122 D WEST MAIN STREET
STAFFORD SPRINGS CT
06076
US

V. Phone/Fax

Practice location:
  • Phone: 860-571-3880
  • Fax:
Mailing address:
  • Phone: 860-684-2350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number001802
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: