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General NPI Number Information
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NPI Number | 1235788407
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Entity Type | Organization
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Legal Business Name | FTN CT HOLDINGS. LLC
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 270 JOHN DOWNEY DR
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City | NEW BRITAIN
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State | CT
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Zip | 06051-2906
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Country | US
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Telephone | 860-612-2309
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Fax | 860-612-2301
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Provider Business Mailing Address
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Address Line | 300 JOHN DOWNEY DR
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City | NEW BRITAIN
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State | CT
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Zip | 06051-2925
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Country | US
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Telephone | 860-612-2312
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL AND CHIEF ADMINISTRATOR
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Name | DR. GWEN KILLHEFFER
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Credential | ED.D.
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Telephone | 860-612-2312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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