Provider Demographics
NPI:1790103018
Name:DOV KUGELMASS
Entity Type:Organization
Organization Name:DOV KUGELMASS
Other - Org Name:DOV KUGELMASS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DOV
Authorized Official - Middle Name:
Authorized Official - Last Name:KUGELMASS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-428-6160
Mailing Address - Street 1:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-0120
Mailing Address - Country:US
Mailing Address - Phone:860-428-6160
Mailing Address - Fax:
Practice Address - Street 1:1066 STORRS RD
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268-2648
Practice Address - Country:US
Practice Address - Phone:860-428-6160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3369103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty