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General NPI Number Information
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NPI Number | 1396870101
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Entity Type | Organization
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Legal Business Name | CMC PSYCHOLOGICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 300 HEBRON AVE STE 215 SUITE 215
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City | GLASTONBURY
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State | CT
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Zip | 06033-2192
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Country | US
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Telephone | 860-657-8545
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Fax | 860-657-8482
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Provider Business Mailing Address
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Address Line | 300 HEBRON AVE STE 215 SUITE 215
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City | GLASTONBURY
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State | CT
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Zip | 06033-2192
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Country | US
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Telephone | 860-657-8545
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Fax | 860-657-8482
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Authorized Official
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Title or Position | MEMBER
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Name | DR. THOMAS MARTIN CARLSON
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Credential | PSY.D.
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Telephone | 860-657-8545
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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 | 002229
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License Number State | CT
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