Provider Demographics
NPI:1255864898
Name:D'ELISA, TERESA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:D'ELISA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ELM ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-5400
Mailing Address - Country:US
Mailing Address - Phone:203-966-9203
Mailing Address - Fax:
Practice Address - Street 1:140 ELM ST
Practice Address - Street 2:SUITE 5
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5400
Practice Address - Country:US
Practice Address - Phone:203-966-9203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3644103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist