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General NPI Number Information
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NPI Number | 1912253071
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Entity Type | Organization
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Legal Business Name | ADVANCED PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 07/26/2012
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Last Update Date | 08/04/2012
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Provider Practice Location Address
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Address Line | 117 E CENTER ST
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City | MANCHESTER
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State | CT
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Zip | 06040-5246
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Country | US
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Telephone | 860-604-9268
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Fax | 860-684-3275
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Provider Business Mailing Address
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Address Line | 12 POTTER RD
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City | STAFFORD SPRINGS
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State | CT
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Zip | 06076-3115
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Country | US
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Telephone | 860-604-9268
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Fax | 860-684-3275
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. ENEIDA M. SILVA
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Credential | PH.D.
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Telephone | 860-604-9268
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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 | 1723
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License Number State | CT
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