MEDICARE: STAMFORD PSYCHIATRIC AND GERIATRIC PSYCHIATRY ASSOCIATES

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	2084P0800X	Psychiatry Physician	23417	CT

General Provider Information

NPI Number	:	1275599516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAMFORD PSYCHIATRIC AND GERIATRIC PSYCHIATRY ASSOCIATES

Provider Business Mailing Address
First Line	:	27 STRAWBERRY HILL CT
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-2514
Country	:	US
Telephone Number	:	203-323-7317
Fax Number	:	203-978-0240

Provider Business Practice Location Address
First Line	:	27 STRAWBERRY HILL CT
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-2514
Country	:	US
Telephone Number	:	203-323-7317
Fax Number	:	203-978-0240

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MARY FORCE
Credential	:
Telephone Number	:	203-323-7317

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	09/14/2007

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