Provider Demographics
NPI:1477543700
Name:STOVER, CARLA SMITH (PHD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:SMITH
Last Name:STOVER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S FRONTAGE RD
Mailing Address - Street 2:CHILD STUDY CENTER, SHM I-WING
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1124
Mailing Address - Country:US
Mailing Address - Phone:203-785-2513
Mailing Address - Fax:203-785-4914
Practice Address - Street 1:230 S FRONTAGE RD
Practice Address - Street 2:CHILD STUDY CENTER, SHM I-WING
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1124
Practice Address - Country:US
Practice Address - Phone:203-785-2513
Practice Address - Fax:203-785-4914
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002503103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist