Provider Demographics
NPI:1255492112
Name:SAZAN, GUITA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:GUITA
Middle Name:A
Last Name:SAZAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:GUITA
Other - Middle Name:A
Other - Last Name:SAZAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:44 STRAWBERRY HILL AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902
Mailing Address - Country:US
Mailing Address - Phone:203-969-2196
Mailing Address - Fax:203-323-9036
Practice Address - Street 1:44 STRAWBERRY HILL AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902
Practice Address - Country:US
Practice Address - Phone:203-969-2196
Practice Address - Fax:203-323-9036
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT02022CT103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT680001158OtherPTAN