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General NPI Number Information
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NPI Number | 1790233831
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Entity Type | Organization
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Legal Business Name | LIESE FRANKLIN-ZITZKAT, PSY.D., LLC
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 09/19/2016
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Provider Practice Location Address
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Address Line | 291 WHITNEY AVE SUITE 303
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City | NEW HAVEN
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State | CT
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Zip | 06511-3724
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Country | US
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Telephone | 203-624-0007
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Fax | 203-624-0007
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Provider Business Mailing Address
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Address Line | 291 WHITNEY AVE SUITE 303
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City | NEW HAVEN
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State | CT
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Zip | 06511-3724
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Country | US
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Telephone | 203-624-0007
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Fax | 203-624-0007
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Authorized Official
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Title or Position | OWNER/CLINICAL PSYCHOLOGIST
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Name | DR. LIESE M. ZITZKAT
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Credential | PSY.D.
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Telephone | 203-624-0007
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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 | 003112
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License Number State | CT
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