Provider Demographics
NPI:1891774360
Name:COVINO, VINCENT A (PHD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:A
Last Name:COVINO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 DEMING ST
Mailing Address - Street 2:PROVIDERCARE PLUS
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3740
Mailing Address - Country:US
Mailing Address - Phone:860-644-4472
Mailing Address - Fax:860-644-3001
Practice Address - Street 1:152 DEMING ST
Practice Address - Street 2:PROVIDERCARE PLUS
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3740
Practice Address - Country:US
Practice Address - Phone:860-644-4472
Practice Address - Fax:860-644-3001
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist