Provider Demographics
NPI:1508899212
Name:PSYCHOLOGICAL HEALTH ASSOCIATES LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL HEALTH ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCI
Authorized Official - Middle Name:B
Authorized Official - Last Name:KORWIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-233-9772
Mailing Address - Street 1:701 COTTAGE GROVE RD STE C210
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-4207
Mailing Address - Country:US
Mailing Address - Phone:860-233-9772
Mailing Address - Fax:860-236-9402
Practice Address - Street 1:701 COTTAGE GROVE RD STE 302
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3080
Practice Address - Country:US
Practice Address - Phone:860-233-9772
Practice Address - Fax:860-236-9402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT=========OtherTAX ID #
CT=========OtherTAX ID #