Healthcare Provider Details

I. General information

NPI: 1750322095
Provider Name (Legal Business Name): NED LYHNE COONEY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 WILLARD AVE VA CONNECTICUT HEALTHCARE SYSTEM /116A-3
NEWINGTON CT
06111-2631
US

IV. Provider business mailing address

555 WILLARD AVE VA CONNECTICUT HEALTHCARE SYSTEM /116A-3
NEWINGTON CT
06111-2631
US

V. Phone/Fax

Practice location:
  • Phone: 860-594-6339
  • Fax: 860-667-6842
Mailing address:
  • Phone: 860-594-6339
  • Fax: 860-667-6842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number001000
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: