MEDICARE: MAUD PURCELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	001990	CT

General Provider Information

NPI Number	:	1134704182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUD PURCELL

Provider Business Mailing Address
First Line	:	500 POST RD E STE 259
Second Line	:
City	:	WESTPORT
State	:	CT
Zip	:	06880-4431
Country	:	US
Telephone Number	:	203-733-9203
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 POST RD E STE 259
Second Line	:
City	:	WESTPORT
State	:	CT
Zip	:	06880-4431
Country	:	US
Telephone Number	:	203-733-9203
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2021
Last Update Date	:	03/11/2021

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Directions to “ MAUD PURCELL ” Practice Location

Language	Start Address	Practice Location

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