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General NPI Number Information
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NPI Number | 1942329685
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Entity Type | Individual
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Provider Name | WILMA JOAN EZEKOWITZ PH.D
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Gender | Female
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 11/14/2018
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Provider Practice Location Address
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Address Line | 295 WASHINGTON AVE STE 11S
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City | HAMDEN
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State | CT
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Zip | 06518-3025
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Country | US
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Telephone | 203-230-0824
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Fax | 203-287-9502
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Provider Business Mailing Address
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Address Line | 295 WASHINGTON AVE STE 11S
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City | HAMDEN
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State | CT
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Zip | 06518-3025
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Country | US
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Telephone | 203-230-0824
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Fax | 203-248-5360
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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 | 001770
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License Number State | CT
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