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General NPI Number Information
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NPI Number | 1326336199
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Entity Type | Organization
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Legal Business Name | WELLSPRING PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 07/14/2011
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Last Update Date | 07/14/2011
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Provider Practice Location Address
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Address Line | 152 SIMSBURY RD # 9B BUILDING 9
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City | AVON
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State | CT
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Zip | 06001-3777
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Country | US
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Telephone | 860-677-2244
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Fax |
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Provider Business Mailing Address
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Address Line | 152 SIMSBURY RD # 9B BUILDING 9
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City | AVON
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State | CT
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Zip | 06001-3777
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Country | US
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Telephone | 860-677-2244
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KERRI L CRANFORD BAKER
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Credential | PSY.D.
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Telephone | 860-677-2244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 003031
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License Number State | CT
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