Healthcare Provider Details

I. General information

NPI: 1659627453
Provider Name (Legal Business Name): STONINGTON PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MASONS ISLAND RD UNIT 4
MYSTIC CT
06355-2958
US

IV. Provider business mailing address

14 MASONS ISLAND RD UNIT 4
MYSTIC CT
06355-2958
US

V. Phone/Fax

Practice location:
  • Phone: 860-245-9222
  • Fax: 860-535-9891
Mailing address:
  • Phone: 860-245-9222
  • Fax: 860-535-9891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number003158
License Number StateCT

VIII. Authorized Official

Name: DR. LINDA W SURIYAKHAM
Title or Position: OWNER
Credential: PHD
Phone: 860-245-9222