Healthcare Provider Details

I. General information

NPI: 1245681386
Provider Name (Legal Business Name): CARLITA FRANCINE ELIAS PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

664 PROSPECT AVE
HARTFORD CT
06105-4203
US

IV. Provider business mailing address

PO BOX 290752
WETHERSFIELD CT
06129-0752
US

V. Phone/Fax

Practice location:
  • Phone: 860-327-5147
  • Fax:
Mailing address:
  • Phone: 860-327-5147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number003543
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: