Provider Demographics
NPI:1508061466
Name:RHODA L KREISMAN PH D
Entity Type:Organization
Organization Name:RHODA L KREISMAN PH D
Other - Org Name:CHILD & FAMILY PSYCHOTHERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RHODA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KREISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PH D LICENSED PSYCH
Authorized Official - Phone:203-265-4036
Mailing Address - Street 1:393 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4206
Mailing Address - Country:US
Mailing Address - Phone:203-265-4036
Mailing Address - Fax:203-284-8302
Practice Address - Street 1:393 CENTER ST
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4206
Practice Address - Country:US
Practice Address - Phone:203-265-4036
Practice Address - Fax:203-284-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty