MEDICARE: STALTARO PSYCHOLOGICAL 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
1	1041C0700X	Clinical Social Worker
2	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1841522216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STALTARO PSYCHOLOGICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	2 CHURCH ST
Second Line	:
City	:	ROCKY HILL
State	:	CT
Zip	:	06067-1518
Country	:	US
Telephone Number	:	860-502-4908
Fax Number	:	860-513-4828

Provider Business Practice Location Address
First Line	:	2 CHURCH ST
Second Line	:
City	:	ROCKY HILL
State	:	CT
Zip	:	06067-1518
Country	:	US
Telephone Number	:	860-502-4908
Fax Number	:	860-513-4828

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PERRY A STALTARO
Credential	:	PSYD
Telephone Number	:	860-502-4908

Provider Enumeration Date	:	02/09/2010
Last Update Date	:	06/30/2024

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