Healthcare Provider Details

I. General information

NPI: 1114992914
Provider Name (Legal Business Name): EMILY B LITTMAN P.H.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY LITTMAN EISEN P.H.D.

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 W MAIN ST
WATERBURY CT
06708-3106
US

IV. Provider business mailing address

1211 W MAIN ST
WATERBURY CT
06708-3106
US

V. Phone/Fax

Practice location:
  • Phone: 203-575-9526
  • Fax: 203-753-9779
Mailing address:
  • Phone: 203-575-9526
  • Fax: 203-753-9779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1033
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: