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General NPI Number Information
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NPI Number | 1518405059
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Entity Type | Organization
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Legal Business Name | PSYCHIATRY ASSOCIATES OF CONNECTICUT
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Dates
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Enumeration Date | 02/04/2017
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 230 MAIN STREET EXT
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City | MIDDLETOWN
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State | CT
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Zip | 06457-4470
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Country | US
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Telephone | 203-245-1579
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Fax | 860-347-8070
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Provider Business Mailing Address
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Address Line | PO BOX 1000
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City | MIDDLETOWN
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State | CT
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Zip | 06457-1000
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Country | US
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Telephone | 203-245-1579
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Fax | 860-347-8070
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Authorized Official
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Title or Position | OWNER
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Name | PAUL T AMBLE
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Credential | MD
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Telephone | 203-245-1579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 0032040
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License Number State | CT
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