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NPI Code Detail

MEDICARE: MARK D LITT PHD

MEDICARE: MARK D LITT 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
1103T00000XPsychologist001441CT
2103TC0700XClinical Psychologist001441CT

General Provider Information

NPI Number : 1972501914
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK D LITT PHD
Provider Business Mailing Address
First Line : 65 KANE ST
Second Line : PROVIDER ENROLLMENT
City : WEST HARTFORD
State : CT
Zip : 06119-2110
Country : US
Telephone Number : 860-523-6421
Fax Number : 860-523-3701
Provider Business Practice Location Address
First Line : 10 TALCOTT NOTCH RD
Second Line :
City : FARMINGTON
State : CT
Zip : 06032-1800
Country : US
Telephone Number : 860-679-6700
Fax Number : 860-679-6736
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2005
Last Update Date : 09/30/2022

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