Provider Demographics
NPI:1689079774
Name:CONNECTICUT PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CONNECTICUT PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GILLIES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-235-3395
Mailing Address - Street 1:5 FLORENCE WAY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-3443
Mailing Address - Country:US
Mailing Address - Phone:860-235-3395
Mailing Address - Fax:888-504-2375
Practice Address - Street 1:4 FOREST PARK DRIVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1443
Practice Address - Country:US
Practice Address - Phone:860-235-3395
Practice Address - Fax:888-504-2375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003346103TC0700X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty