MEDICARE: DR. XOLI REDMOND PSY.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	3209	CT
2	103TC0700X	Clinical Psychologist	3209	CT
3	103TC2200X	Clinical Child & Adolescent Psychologist	3209	CT
4	103TA0400X	Addiction (Substance Use Disorder) Psychologist	3209	CT
5	103TB0200X	Cognitive & Behavioral Psychologist	3209	CT
6	103TF0000X	Family Psychologist	3209	CT

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1437434917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. XOLI REDMOND PSY.D.

Provider Business Mailing Address
First Line	:	436 ORANGE ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-6402
Country	:	US
Telephone Number	:	203-772-8882
Fax Number	:

Provider Business Practice Location Address
First Line	:	436 ORANGE ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-6402
Country	:	US
Telephone Number	:	203-772-8882
Fax Number	:

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

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	09/04/2015

10 UNION SQ E , BETH ISRAEL MED CTR- DEPT OF REHAB MEDICARE
NEW YORK, NY
10003-3314

Practice Phone: 212-420-2757
Practice Fax: