=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215647524
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER NICOLE WIMMER-HAMAN PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2022
-----------------------------------------------------
Last Update Date | 04/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 CONNECTICUT BLVD FL 1
-----------------------------------------------------
City | EAST HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06108-7303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-837-7250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 79 OAKWOOD AVE
-----------------------------------------------------
City | WEST HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06119-2174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-765-0833
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 004337
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------