Provider Demographics
NPI:1174674519
Name:ISRAEL, DAVID J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:ISRAEL
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 1:1250 SUMMER ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5358
Mailing Address - Country:US
Mailing Address - Phone:203-359-8458
Mailing Address - Fax:203-387-0310
Practice Address - Street 1:1250 SUMMER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5358
Practice Address - Country:US
Practice Address - Phone:203-359-8458
Practice Address - Fax:203-387-0310
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001819103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical