MEDICARE: DR. W. DEAN PFEIFER PHD

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	103TC0700X	Clinical Psychologist	000932	CT

Other Identifiers

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

General Provider Information

NPI Number	:	1487628624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. W. DEAN PFEIFER PHD

Provider Business Mailing Address
First Line	:	149 DURHAM ROAD
Second Line	:	SUITE 31
City	:	MADISON
State	:	CT
Zip	:	06443-2664
Country	:	US
Telephone Number	:	203-245-1956
Fax Number	:	203-245-6710

Provider Business Practice Location Address
First Line	:	149 DURHAM RD 31
Second Line	:
City	:	MADISON
State	:	CT
Zip	:	06443-2664
Country	:	US
Telephone Number	:	203-245-1956
Fax Number	:	203-245-6710

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/08/2015

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