Healthcare Provider Details

I. General information

NPI: 1083934186
Provider Name (Legal Business Name): TALINE ELIZABETH ANDONIAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 ARBOR ST
HARTFORD CT
06106-1222
US

IV. Provider business mailing address

425 GEORGE ST
NEW HAVEN CT
06511-5410
US

V. Phone/Fax

Practice location:
  • Phone: 860-451-1199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number003345
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: