Provider Demographics
NPI:1821425208
Name:FRANKLIN, DEREK A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:A
Last Name:FRANKLIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 NEW PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2170
Mailing Address - Country:US
Mailing Address - Phone:860-586-2318
Mailing Address - Fax:860-586-2344
Practice Address - Street 1:151 NEW PARK AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2170
Practice Address - Country:US
Practice Address - Phone:860-586-2318
Practice Address - Fax:860-586-2344
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001703103TC0700X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical