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General NPI Number Information
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NPI Number | 1336248806
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Entity Type | Individual
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Provider Name | PETER D RADASCH PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 41 N MAIN ST
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City | WEST HARTFORD
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State | CT
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Zip | 06107-1972
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Country | US
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Telephone | 860-539-0185
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Fax | 860-439-2087
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Provider Business Mailing Address
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Address Line | 2440 WESTERN AVE APT 715
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City | SEATTLE
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State | WA
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Zip | 98121-3304
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Country | US
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Telephone | 860-236-7333
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Fax | 860-439-2087
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 002295
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License Number State | CT
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