Provider Demographics
NPI:1073671939
Name:DREYFUS, COLLEEN KELLER (PHD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:KELLER
Last Name:DREYFUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 D WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:STAFFORD SPRINGS
Mailing Address - State:CT
Mailing Address - Zip Code:06076
Mailing Address - Country:US
Mailing Address - Phone:860-684-2350
Mailing Address - Fax:
Practice Address - Street 1:191 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-1386
Practice Address - Country:US
Practice Address - Phone:860-571-3880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001802103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
741694OtherMAGELLAN
C009513OtherCHAMPUS
845341OtherFIRST HEALTH
ZS284OtherOXFORD
060001802CT03OtherANTHEM
080315OtherMHN
121201OtherCOMPYSCH
6151571OtherUBH