Provider Demographics
NPI:1073931366
Name:KUGELMASS, DOV (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOV
Middle Name:
Last Name:KUGELMASS
Suffix:
Gender:M
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:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-0120
Mailing Address - Country:US
Mailing Address - Phone:860-428-6160
Mailing Address - Fax:
Practice Address - Street 1:1066 STORRS RD
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268-2648
Practice Address - Country:US
Practice Address - Phone:860-428-6160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3369103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist