Provider Demographics
NPI:1033372966
Name:ZITZKAT, LIESE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LIESE
Middle Name:M
Last Name:ZITZKAT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:LIESE
Other - Middle Name:
Other - Last Name:FRANKLIN-ZITZKAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:291 WHITNEY AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3724
Mailing Address - Country:US
Mailing Address - Phone:203-624-0007
Mailing Address - Fax:
Practice Address - Street 1:291 WHITNEY AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3724
Practice Address - Country:US
Practice Address - Phone:203-624-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9084103TC0700X
CT3112103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0300010OtherMBHP
MA1300881Medicaid