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General NPI Number Information
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NPI Number | 1396772232
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Entity Type | Individual
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Provider Name | WESLEY L VINCENT PHD
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Gender | Male
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 10/26/2012
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Provider Practice Location Address
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Address Line | 139 HAZARD AVE SUITE 7
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City | ENFIELD
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State | CT
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Zip | 06082-4597
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Country | US
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Telephone | 860-763-4465
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Fax | 860-763-4467
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Provider Business Mailing Address
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Address Line | 206 BOSTON TPKE
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City | POMFRET CENTER
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State | CT
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Zip | 06259-9514
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Country | US
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Telephone | 860-974-2994
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Fax | 860-974-2994
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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 | 001556
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License Number State | CT
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