Healthcare Provider Details

I. General information

NPI: 1194940916
Provider Name (Legal Business Name): KIMBERLEE J SASS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 WHITNEY AVE SUITE 402
NEW HAVEN CT
06511-3724
US

IV. Provider business mailing address

1040 MOUNT CARMEL AVE
HAMDEN CT
06518-1608
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-1300
  • Fax: 866-596-7112
Mailing address:
  • Phone: 203-281-3060
  • Fax: 866-596-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberCT01234
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: