Healthcare Provider Details

I. General information

NPI: 1083300792
Provider Name (Legal Business Name): BETHANY CAUDILL PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

682 PROSPECT AVE
HARTFORD CT
06105-4238
US

IV. Provider business mailing address

6 DEERFIELD RD
BLOOMFIELD CT
06002-5017
US

V. Phone/Fax

Practice location:
  • Phone: 540-526-5119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5438
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: