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General NPI Number Information
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NPI Number | 1134996523
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Entity Type | Organization
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Legal Business Name | GREENWICH CHILD PSYCHOLOGY LLC
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Dates
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Enumeration Date | 12/06/2023
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Last Update Date | 12/08/2023
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Provider Practice Location Address
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Address Line | 15 VALLEY DR STE 1
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City | GREENWICH
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State | CT
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Zip | 06831-5205
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Country | US
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Telephone | 203-900-1666
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Fax |
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Provider Business Mailing Address
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Address Line | 15 VALLEY DR STE 1
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City | GREENWICH
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State | CT
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Zip | 06831-5205
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Country | US
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Telephone | 203-900-1666
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR, FOUNDER
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Name | DR. JUDITH ZACKSON
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Credential | PHD
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Telephone | 203-900-1666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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