Provider Demographics
NPI:1487628624
Name:PFEIFER, W. DEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:W. DEAN
Middle Name:
Last Name:PFEIFER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 DURHAM ROAD
Mailing Address - Street 2:SUITE 31
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2664
Mailing Address - Country:US
Mailing Address - Phone:203-245-1956
Mailing Address - Fax:203-245-6710
Practice Address - Street 1:149 DURHAM RD 31
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2664
Practice Address - Country:US
Practice Address - Phone:203-245-1956
Practice Address - Fax:203-245-6710
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000932103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004114352Medicaid
CT680000878Medicare ID - Type Unspecified