Provider Demographics
NPI:1578052114
Name:CARA LATTIZORI NGUYEN, PSY.D., LLC
Entity Type:Organization
Organization Name:CARA LATTIZORI NGUYEN, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARA
Authorized Official - Middle Name:SIENA
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-307-0379
Mailing Address - Street 1:PO BOX 735
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06057-0735
Mailing Address - Country:US
Mailing Address - Phone:860-307-0379
Mailing Address - Fax:
Practice Address - Street 1:85 RIVER RD STE A
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06019-3245
Practice Address - Country:US
Practice Address - Phone:860-307-0379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002940103TP2701X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty