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General NPI Number Information
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NPI Number | 1356691901
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Entity Type | Organization
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Legal Business Name | VICKI GARVIN, PH.D., LLC
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 1420 MAIN STREET SUITE 203
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City | GLASTONBURY
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State | CT
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Zip | 06033-3110
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Country | US
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Telephone | 860-659-3244
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 MAIN STREET SUITE 203
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City | GLASTONBURY
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State | CT
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Zip | 06033
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Country | US
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Telephone | 860-659-3244
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | VICKI GARVIN
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Credential | PH.D., LLC
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Telephone | 860-659-3244
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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 | 001617
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License Number State | CT
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