Provider Demographics
NPI:1326583824
Name:SEASIDE PSYCHOLOGICAL
Entity Type:Organization
Organization Name:SEASIDE PSYCHOLOGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:203-530-3392
Mailing Address - Street 1:19 W COVE RD
Mailing Address - Street 2:
Mailing Address - City:MOODUS
Mailing Address - State:CT
Mailing Address - Zip Code:06469-1300
Mailing Address - Country:US
Mailing Address - Phone:203-530-3392
Mailing Address - Fax:
Practice Address - Street 1:19 W COVE RD
Practice Address - Street 2:
Practice Address - City:MOODUS
Practice Address - State:CT
Practice Address - Zip Code:06469-1300
Practice Address - Country:US
Practice Address - Phone:203-530-3392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002182103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty