Provider Demographics
NPI:1659794337
Name:VAUGHN, GRETCHEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:GRETCHEN
Other - Middle Name:
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1593 ELLA GRASSO BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2921
Mailing Address - Country:US
Mailing Address - Phone:203-641-5056
Mailing Address - Fax:203-397-0457
Practice Address - Street 1:1593 ELLA GRASSO BLVD FL 3
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2921
Practice Address - Country:US
Practice Address - Phone:203-641-5056
Practice Address - Fax:203-397-0457
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002126103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical