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General NPI Number Information
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NPI Number | 1700341021
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Entity Type | Organization
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Legal Business Name | HEART OF WISDOM COUNSELING AND PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 06/24/2021
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Provider Practice Location Address
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Address Line | 41C NEW LONDON TPKE
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City | GLASTONBURY
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State | CT
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Zip | 06033-4206
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Country | US
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Telephone | 860-288-7041
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Fax |
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Provider Business Mailing Address
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Address Line | 181 NORTH ST
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City | HEBRON
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State | CT
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Zip | 06248-1125
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Country | US
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Telephone | 917-445-6423
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/MEMBER
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Name | DR. SMITH KIDKARNDEE
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Credential | PSY.D.
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Telephone | 917-445-6423
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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