Provider Demographics
NPI:1477625150
Name:DOBO, COLEEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:COLEEN
Middle Name:
Last Name:DOBO
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 1:11 WALTS HL
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-1202
Mailing Address - Country:US
Mailing Address - Phone:860-286-9324
Mailing Address - Fax:
Practice Address - Street 1:11 WALTS HL
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-1202
Practice Address - Country:US
Practice Address - Phone:860-372-9437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002430103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT680001610Medicare ID - Type UnspecifiedPROVIDER MEDICARE NUMBER