Healthcare Provider Details

I. General information

NPI: 1841522216
Provider Name (Legal Business Name): STALTARO PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 06/30/2024
Certification Date: 06/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CHURCH ST
ROCKY HILL CT
06067-1518
US

IV. Provider business mailing address

2 CHURCH ST
ROCKY HILL CT
06067-1518
US

V. Phone/Fax

Practice location:
  • Phone: 860-502-4908
  • Fax: 860-513-4828
Mailing address:
  • Phone: 860-502-4908
  • Fax: 860-513-4828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. PERRY A STALTARO
Title or Position: PRESIDENT
Credential: PSYD
Phone: 860-502-4908