Provider Demographics
NPI:1508912205
Name:BANGS, KENNETH P (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:P
Last Name:BANGS
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 1:99 DYER AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06019-3233
Mailing Address - Country:US
Mailing Address - Phone:860-693-1880
Mailing Address - Fax:860-793-3591
Practice Address - Street 1:91 NORTHWEST DR
Practice Address - Street 2:WHEELER CLINIC
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1534
Practice Address - Country:US
Practice Address - Phone:860-793-3816
Practice Address - Fax:860-793-3591
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1523103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical