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General NPI Number Information
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NPI Number | 1891879920
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Entity Type | Individual
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Provider Name | GERALDINE M LENZ PHD
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 05/05/2021
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Provider Practice Location Address
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Address Line | 836 FARMINGTON AVE STE 217B
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1545
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Country | US
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Telephone | 860-522-0665
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Fax | 860-278-8338
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Provider Business Mailing Address
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Address Line | 836 FARMINGTON AVE STE 217B
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1545
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Country | US
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Telephone | 860-522-0665
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Fax | 860-278-8338
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0063481
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2419
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 000824
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License Number State | CT
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