Provider Demographics
NPI:1578706560
Name:CAROL C. HENDRICKS, PH.D.
Entity Type:Organization
Organization Name:CAROL C. HENDRICKS, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-644-5301
Mailing Address - Street 1:11 ELMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3903
Mailing Address - Country:US
Mailing Address - Phone:203-644-5301
Mailing Address - Fax:203-293-4741
Practice Address - Street 1:728 POST RD E
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5200
Practice Address - Country:US
Practice Address - Phone:203-644-5301
Practice Address - Fax:203-293-4741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002836103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty