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General NPI Number Information
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NPI Number | 1740663913
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Entity Type | Organization
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Legal Business Name | MITCHELL DANITZ, PH.D., LLC
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Dates
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Enumeration Date | 07/06/2015
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Last Update Date | 07/06/2015
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Provider Practice Location Address
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Address Line | 45 S MAIN ST SUITE 110
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2441
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Country | US
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Telephone | 860-231-7227
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Fax | 866-990-8973
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Provider Business Mailing Address
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Address Line | 45 S MAIN ST SUITE 110
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2441
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Country | US
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Telephone | 860-231-7227
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Fax | 866-990-8973
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | MITCHELL DANITZ
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Credential | PH.D.
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Telephone | 860-231-7227
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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 | 001530
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License Number State | CT
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