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General NPI Number Information
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NPI Number | 1598051591
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Entity Type | Individual
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Provider Name | VAMSI KONERU PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2011
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 176 W MAIN ST
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City | AVON
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State | CT
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Zip | 06001-4354
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Country | US
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Telephone | 305-321-5384
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Fax |
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Provider Business Mailing Address
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Address Line | 176 W MAIN ST
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City | AVON
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State | CT
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Zip | 06001-4354
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Country | US
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Telephone | 305-321-5384
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 003122
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License Number State | CT
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