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General NPI Number Information
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NPI Number | 1275717019
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Entity Type | Organization
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Legal Business Name | CENTER FOR FAMILY & INDIVIDUAL PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 76 S FRONTAGE RD
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City | VERNON
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State | CT
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Zip | 06066-5535
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Country | US
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Telephone | 860-872-4570
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Fax | 860-896-1023
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Provider Business Mailing Address
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Address Line | 76 SOUTH FRONTAGE ROAD P.O. BOX 2333
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City | VERNON
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State | CT
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Zip | 06066-2250
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Country | US
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Telephone | 860-872-4570
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Fax | 860-896-1023
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. JOSEPH ANTHONY HORTON
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Credential | PH.D.
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Telephone | 860-872-4570
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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 | 703
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License Number State | CT
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