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General NPI Number Information
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NPI Number | 1013037860
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Entity Type | Individual
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Provider Name | SANDRA E. HARTDAGEN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 148 EASTERN BLVD
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City | GLASTONBURY
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State | CT
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Zip | 06033-4321
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Country | US
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Telephone | 860-652-3687
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Fax |
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Provider Business Mailing Address
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Address Line | 282 OAK ST
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-2342
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Country | US
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Telephone | 860-648-9400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 001580
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License Number State | CT
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