Provider Demographics
NPI:1508394834
Name:CT PSYCHOLOGICAL CONSULTING SERVICES, LLC
Entity Type:Organization
Organization Name:CT PSYCHOLOGICAL CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LASHANDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-578-4779
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06141-0011
Mailing Address - Country:US
Mailing Address - Phone:860-578-4779
Mailing Address - Fax:
Practice Address - Street 1:210 WETHERSFIELD AVE FL 2
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-1113
Practice Address - Country:US
Practice Address - Phone:860-578-4779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003043103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty