Provider Demographics
NPI:1437286614
Name:PALMISANO, CYNTHIA A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:A
Last Name:PALMISANO
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 1:260 AMITY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2222
Mailing Address - Country:US
Mailing Address - Phone:032-984-5722
Mailing Address - Fax:203-298-9007
Practice Address - Street 1:260 AMITY RD STE 202
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2222
Practice Address - Country:US
Practice Address - Phone:032-984-5722
Practice Address - Fax:203-298-9007
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT103T00000X
CT2896103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1437286614OtherNPPES