Healthcare Provider Details

I. General information

NPI: 1811153612
Provider Name (Legal Business Name): CHRISTINA M. GILLIAM PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RETREAT AVE HARTFORD HOSPITAL ANXIETY DISORDERS CENTER
HARTFORD CT
06106-3309
US

IV. Provider business mailing address

HARTFORD HOSPITAL PROFESSIONAL SERVICES PO BOX 40,000 DEPT 634
HARTFORD CT
06151-0001
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-7685
  • Fax:
Mailing address:
  • Phone: 860-545-7602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number002880
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: