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General NPI Number Information
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NPI Number | 1508394834
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Entity Type | Organization
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Legal Business Name | CT PSYCHOLOGICAL CONSULTING SERVICES, LLC
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 05/31/2017
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Provider Practice Location Address
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Address Line | 210 WETHERSFIELD AVE FL 2
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City | HARTFORD
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State | CT
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Zip | 06114-1113
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Country | US
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Telephone | 860-578-4779
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11
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City | HARTFORD
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State | CT
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Zip | 06141-0011
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Country | US
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Telephone | 860-578-4779
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LASHANDA B HARVEY
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Credential | PSY.D
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Telephone | 860-578-4779
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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 | 003043
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License Number State | CT
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