Healthcare Provider Details

I. General information

NPI: 1790233831
Provider Name (Legal Business Name): LIESE FRANKLIN-ZITZKAT, PSY.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 WHITNEY AVE SUITE 303
NEW HAVEN CT
06511-3724
US

IV. Provider business mailing address

291 WHITNEY AVE SUITE 303
NEW HAVEN CT
06511-3724
US

V. Phone/Fax

Practice location:
  • Phone: 203-624-0007
  • Fax: 203-624-0007
Mailing address:
  • Phone: 203-624-0007
  • Fax: 203-624-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number003112
License Number StateCT

VIII. Authorized Official

Name: DR. LIESE M. ZITZKAT
Title or Position: OWNER/CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 203-624-0007