Healthcare Provider Details

I. General information

NPI: 1396078986
Provider Name (Legal Business Name): TERRLYN L CURRY AVERY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BAYONET ST SUITE 304
NEW LONDON CT
06320-2600
US

IV. Provider business mailing address

400 BAYONET ST SUITE 304
NEW LONDON CT
06320-2600
US

V. Phone/Fax

Practice location:
  • Phone: 860-443-7505
  • Fax: 860-444-8895
Mailing address:
  • Phone: 860-443-7505
  • Fax: 860-444-8895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number002364
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: