Healthcare Provider Details

I. General information

NPI: 1518154038
Provider Name (Legal Business Name): STEPHANIE BOZAK PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 04/26/2022
Certification Date: 04/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 HUDSON STREET 8TH FLOOR
HARTFORD CT
06106
US

IV. Provider business mailing address

50 OLD MEADOW PLAIN RD
SIMSBURY CT
06070-2733
US

V. Phone/Fax

Practice location:
  • Phone: 860-936-1256
  • Fax:
Mailing address:
  • Phone: 860-819-3093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3927
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: