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General NPI Number Information
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NPI Number | 1801119888
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Entity Type | Organization
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Legal Business Name | GLORIA SMALL, PHD. PC
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Dates
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Enumeration Date | 03/05/2010
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Last Update Date | 03/05/2010
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Provider Practice Location Address
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Address Line | 26 LONG HILL RD
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City | GUILFORD
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State | CT
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Zip | 06437-1870
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Country | US
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Telephone | 203-453-2932
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Fax |
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Provider Business Mailing Address
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Address Line | 26 LONG HILL RD
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City | GUILFORD
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State | CT
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Zip | 06437-1870
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Country | US
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Telephone | 203-453-2932
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | GLORIA SMALL
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Credential |
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Telephone | 203-453-2932
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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 | 001413
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License Number State | CT
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