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General NPI Number Information
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NPI Number | 1720716525
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Entity Type | Organization
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Legal Business Name | SOMERVILLE PSYCH CONSULTATION INC.
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Dates
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Enumeration Date | 08/10/2022
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 201 W 4TH ST SUITE 205
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City | CLAREMONT
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State | CA
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Zip | 91711
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Country | US
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Telephone | 626-202-5550
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Fax | 626-270-7002
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Provider Business Mailing Address
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Address Line | PO BOX 1196
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City | CLAREMONT
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State | CA
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Zip | 91711
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Country | US
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Telephone | 626-202-5550
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Fax | 626-270-7002
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT CONNOLLY
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Credential | PSY.D
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Telephone | 626-202-5550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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