Provider Demographics
NPI:1790310787
Name:VERHAAK, ALLISON (PHD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:VERHAAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-3537
Mailing Address - Country:US
Mailing Address - Phone:207-577-0826
Mailing Address - Fax:
Practice Address - Street 1:327 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-3537
Practice Address - Country:US
Practice Address - Phone:207-577-0826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2023-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3909103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical