Provider Demographics
NPI:1598707952
Name:ADULT AND ADOLESCENT PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:ADULT AND ADOLESCENT PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEITER-SANDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-633-7882
Mailing Address - Street 1:78 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4325
Mailing Address - Country:US
Mailing Address - Phone:860-633-7882
Mailing Address - Fax:860-659-1999
Practice Address - Street 1:78 EASTERN BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4325
Practice Address - Country:US
Practice Address - Phone:860-633-7882
Practice Address - Fax:860-659-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2083103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT680001142Medicare ID - Type UnspecifiedDR. DEITER-SANDS MED. #