Provider Demographics
NPI:1891879920
Name:LENZ, GERALDINE M (PHD)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:M
Last Name:LENZ
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 1:836 FARMINGTON AVE STE 217B
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1545
Mailing Address - Country:US
Mailing Address - Phone:860-522-0665
Mailing Address - Fax:860-278-8338
Practice Address - Street 1:836 FARMINGTON AVE STE 217B
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1545
Practice Address - Country:US
Practice Address - Phone:860-522-0665
Practice Address - Fax:860-278-8338
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0063481103TC0700X
MA2419103TC0700X
CT000824103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP611725OtherOXFORD
CT006645OtherVALUE OPTIONS
CT0004230714OtherAETNA
CT060000824CT01OtherANTHEM