Provider Demographics
NPI:1225587041
Name:VIOLETTE, BRYAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:VIOLETTE
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 1:24 JAMESWELL RD
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2827
Mailing Address - Country:US
Mailing Address - Phone:860-729-1172
Mailing Address - Fax:
Practice Address - Street 1:179 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6672
Practice Address - Country:US
Practice Address - Phone:860-387-7925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3586103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist