Healthcare Provider Details

I. General information

NPI: 1952356537
Provider Name (Legal Business Name): PSYCH ASSOCIATES NEW ENGLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PROSPECT ST
PUTNAM CT
06260-2127
US

IV. Provider business mailing address

PO BOX 470
PUTNAM CT
06260-0470
US

V. Phone/Fax

Practice location:
  • Phone: 860-792-1608
  • Fax:
Mailing address:
  • Phone: 860-792-1608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. JANE M FERRI
Title or Position: PRESIDENT OF CORPORATION
Credential: LCSW
Phone: 860-792-1608