=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093950032
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YALE PARENTING AND CHILD CONDUCT CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2008
-----------------------------------------------------
Last Update Date | 12/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 314 PROSPECT ST
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06511-2187
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-432-9993
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 314 PROSPECT ST
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06511-2187
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-432-9993
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. ALAN KAZDIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-432-9993
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------