Provider Demographics
NPI:1053478693
Name:TAYLOR, VIRGINIA DALTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:DALTON
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:GINNIE
Other - Middle Name:DALTON
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1095 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3432
Mailing Address - Country:US
Mailing Address - Phone:203-271-3809
Mailing Address - Fax:203-272-6968
Practice Address - Street 1:1095 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3432
Practice Address - Country:US
Practice Address - Phone:203-271-3809
Practice Address - Fax:203-272-6968
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20270103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical