Healthcare Provider Details

I. General information

NPI: 1215864277
Provider Name (Legal Business Name): NAKISA GHANNAD PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 LONG LOTS RD
WESTPORT CT
06880-3828
US

IV. Provider business mailing address

360 STATE ST APT 2707
NEW HAVEN CT
06510-3627
US

V. Phone/Fax

Practice location:
  • Phone: 203-227-1251
  • Fax:
Mailing address:
  • Phone: 813-625-8580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5303
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: