Healthcare Provider Details

I. General information

NPI: 1275615163
Provider Name (Legal Business Name): REBECCA CHAISON CHRISTIAN-PARILLA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MAIN ST
NEW PRESTON CT
06777-1716
US

IV. Provider business mailing address

10 MAIN ST P.O. BOX 2219
NEW PRESTON CT
06777-1716
US

V. Phone/Fax

Practice location:
  • Phone: 860-868-2300
  • Fax: 860-868-0055
Mailing address:
  • Phone: 860-868-2300
  • Fax: 860-868-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2404
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: