Provider Demographics
NPI:1114033792
Name:SARFATY, STEPHEN D (PSYD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:D
Last Name:SARFATY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001011103G00000X, 103TC0700X
NY0117061103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060001011CT01OtherANTHEM PROV #