Provider Demographics
NPI:1164158085
Name:ALLIANCE - PSYCHOLOGY ADVOCACY & SUPPORT LLC
Entity Type:Organization
Organization Name:ALLIANCE - PSYCHOLOGY ADVOCACY & SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-232-7956
Mailing Address - Street 1:1393 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1899
Mailing Address - Country:US
Mailing Address - Phone:203-232-7956
Mailing Address - Fax:203-298-6254
Practice Address - Street 1:195 S MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3171
Practice Address - Country:US
Practice Address - Phone:203-232-7956
Practice Address - Fax:203-298-6254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-25
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTNONEOtherNONE. THE PROGRAM MADE ME ADD SOMETHING.
CT3129OtherCT LICENSE PSYCHOLOGY