Provider Demographics
NPI:1992838247
Name:KILLIAN, NANCY E (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:E
Last Name:KILLIAN
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:PO BOX 831
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-0831
Mailing Address - Country:US
Mailing Address - Phone:203-319-0236
Mailing Address - Fax:203-319-0236
Practice Address - Street 1:1241 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6025
Practice Address - Country:US
Practice Address - Phone:203-319-0236
Practice Address - Fax:203-319-0236
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002078103TC1900X
CT060002078103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060002078CT01OtherANTHEM PROVIDER ID
CT336733OtherVALUE OPTIONS PROVIDER #
CT680001250Medicare ID - Type UnspecifiedPROVIDER