Healthcare Provider Details

I. General information

NPI: 1851621627
Provider Name (Legal Business Name): DAVID S WHEELER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2009
Last Update Date: 12/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 STORRS RD
MANSFIELD CENTER CT
06250-1683
US

IV. Provider business mailing address

189 STORRS RD
MANSFIELD CENTER CT
06250-1683
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-1311
  • Fax: 860-423-6114
Mailing address:
  • Phone: 860-456-1311
  • Fax: 860-423-6114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number001783
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: