=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538209069
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FELICE S GERBER PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 01/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 287 WEST ST
-----------------------------------------------------
City | ROCKY HILL
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06067-3501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-721-5935
-----------------------------------------------------
Fax | 860-721-5979
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 ELLSWORTH ST APT 1
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06605-3179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 002075
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------