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General NPI Number Information
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NPI Number | 1487947701
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Entity Type | Organization
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Legal Business Name | GLORIA SMALL PHD LLC
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Dates
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Enumeration Date | 05/19/2011
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 65 TRUMBULL ST
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City | NEW HAVEN
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State | CT
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Zip | 06510-1031
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Country | US
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Telephone | 203-453-2932
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Fax |
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Provider Business Mailing Address
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Address Line | 65 TRUMBULL ST
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City | NEW HAVEN
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State | CT
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Zip | 06510-1031
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Country | US
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Telephone | 203-453-2932
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | GLORIA SMALLP
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Credential | PHD
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Telephone | 203-453-2932
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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 | OO1413
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License Number State | CT
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