Healthcare Provider Details

I. General information

NPI: 1700179702
Provider Name (Legal Business Name): KATHERINE D TSATSANIS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S FRONTAGE RD
NEW HAVEN CT
06519-1124
US

IV. Provider business mailing address

230 S FRONTAGE RD
NEW HAVEN CT
06519-1124
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-6115
  • Fax: 203-737-4197
Mailing address:
  • Phone: 203-785-6115
  • Fax: 203-737-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number002363
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number002363
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number002363
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: