Healthcare Provider Details

I. General information

NPI: 1871020974
Provider Name (Legal Business Name): KRISTIN E SLYNE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 07/21/2022
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 Number003579
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number003579
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: