Healthcare Provider Details

I. General information

NPI: 1508409731
Provider Name (Legal Business Name): CLUFOIR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1783 MERIDEN WATERBURY TPKE SUITE K 11
SOUTHINGTON CT
06489-0268
US

IV. Provider business mailing address

102 PEMBROKE RD
HAMDEN CT
06514-2626
US

V. Phone/Fax

Practice location:
  • Phone: 203-404-1010
  • Fax: 860-426-2898
Mailing address:
  • Phone: 203-404-1010
  • Fax: 860-426-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVENDER PANWAR
Title or Position: OWNER
Credential: BE, ME
Phone: 203-404-1010