Healthcare Provider Details

I. General information

NPI: 1841342037
Provider Name (Legal Business Name): ILA SHARON SABINO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RETREAT AVE HARTFORD HOSPITAL PSYCHIATRY DEPT
HARTFORD CT
06106-3309
US

IV. Provider business mailing address

200 RETREAT AVE HARTFORD HOSPITAL PSYCHIATRY DEPT
HARTFORD CT
06106-3309
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-7940
  • Fax:
Mailing address:
  • Phone: 860-545-7940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number016619-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9321
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number003394
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: