Provider Demographics
NPI:1518405059
Name:PSYCHIATRY ASSOCIATES OF CONNECTICUT
Entity Type:Organization
Organization Name:PSYCHIATRY ASSOCIATES OF CONNECTICUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:T
Authorized Official - Last Name:AMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-245-1579
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-1000
Mailing Address - Country:US
Mailing Address - Phone:203-245-1579
Mailing Address - Fax:860-347-8070
Practice Address - Street 1:230 MAIN STREET EXT
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4470
Practice Address - Country:US
Practice Address - Phone:203-245-1579
Practice Address - Fax:860-347-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-04
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0032040103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty