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NPI Code Detail

MEDICARE: HARTFORD PSYCHOLOGICAL SERVICES, LLC

MEDICARE: HARTFORD 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
11041C0700XClinical Social Worker1041C0700XCT
2103T00000XPsychologist103T00000XCT

Other Identifiers

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

General Provider Information

NPI Number : 1891989026
Entity Type Code : Organization
Provider Name (Legal Business Name) : HARTFORD PSYCHOLOGICAL SERVICES, LLC
Provider Business Mailing Address
First Line : 210 WETHERSFIELD AVE
Second Line :
City : HARTFORD
State : CT
Zip : 06114-1113
Country : US
Telephone Number : 860-296-0094
Fax Number : 860-206-1184
Provider Business Practice Location Address
First Line : 210 WETHERSFIELD AVE
Second Line :
City : HARTFORD
State : CT
Zip : 06114-1113
Country : US
Telephone Number : 860-296-0094
Fax Number : 860-206-1184
Authorized Official
Title or Position : DIRECTOR
Name : DR. RAFAEL MORA DE JESUS
Credential : PH.D.
Telephone Number : 860-296-0094
Provider Enumeration Date : 08/30/2007
Last Update Date : 01/26/2015

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