Healthcare Provider Details

I. General information

NPI: 1033372966
Provider Name (Legal Business Name): LIESE M ZITZKAT PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LIESE FRANKLIN-ZITZKAT PSY.D.

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 08/11/2011
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:
Mailing address:
  • Phone: 203-624-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9084
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3112
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: