Provider Demographics
NPI:1497151245
Name:CONNECTICUT NEUROPSYCHOLOGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CONNECTICUT NEUROPSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:CLARUS HEALTH ALLIANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-889-7274
Mailing Address - Street 1:150 OTROBANDO AVE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2116
Mailing Address - Country:US
Mailing Address - Phone:860-889-7274
Mailing Address - Fax:860-889-2131
Practice Address - Street 1:150 OTROBANDO AVE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2116
Practice Address - Country:US
Practice Address - Phone:860-889-7274
Practice Address - Fax:860-889-2131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003313103G00000X, 103T00000X, 103TC0700X
CT003357103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty