Provider Demographics
NPI:1114992914
Name:LITTMAN, EMILY B (PHD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:B
Last Name:LITTMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:EMILY
Other - Middle Name:LITTMAN
Other - Last Name:EISEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1211 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3106
Mailing Address - Country:US
Mailing Address - Phone:203-575-9526
Mailing Address - Fax:203-753-9779
Practice Address - Street 1:1211 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3106
Practice Address - Country:US
Practice Address - Phone:203-575-9526
Practice Address - Fax:203-753-9779
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1033103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT620000110Medicare ID - Type Unspecified