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General NPI Number Information
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NPI Number | 1275629099
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Entity Type | Individual
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Provider Name | EDITH PETRELLO HEATH PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 400 NORTH STREET
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City | NORFOLK
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State | CT
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Zip | 06058-0562
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Country | US
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Telephone | 860-542-6941
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Fax | 860-542-5096
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Provider Business Mailing Address
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Address Line | 400 NORTH STREET PO BOX 562
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City | NORFOLK
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State | CT
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Zip | 06058-0562
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Country | US
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Telephone | 860-542-6941
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Fax | 860-542-5096
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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 | 738
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License Number State | CT
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