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NPI Code Detail

MEDICARE: CT PSYCHOLOGICAL CONSULTING SERVICES, LLC

MEDICARE: CT PSYCHOLOGICAL CONSULTING SERVICES, LLC
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
1103TC0700XClinical Psychologist003043CT

General Provider Information

NPI Number : 1508394834
Entity Type Code : Organization
Provider Name (Legal Business Name) : CT PSYCHOLOGICAL CONSULTING SERVICES, LLC
Provider Business Mailing Address
First Line : PO BOX 11
Second Line :
City : HARTFORD
State : CT
Zip : 06141-0011
Country : US
Telephone Number : 860-578-4779
Fax Number :
Provider Business Practice Location Address
First Line : 210 WETHERSFIELD AVE FL 2
Second Line :
City : HARTFORD
State : CT
Zip : 06114-1113
Country : US
Telephone Number : 860-578-4779
Fax Number :
Authorized Official
Title or Position : OWNER
Name : LASHANDA B HARVEY
Credential : PSY.D
Telephone Number : 860-578-4779
Provider Enumeration Date : 05/31/2017
Last Update Date : 05/31/2017

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