Provider Demographics
NPI:1013084672
Name:CONTI, JAMES M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:CONTI
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:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-0423
Mailing Address - Country:US
Mailing Address - Phone:860-268-2020
Mailing Address - Fax:860-659-4358
Practice Address - Street 1:41C NEW LONDON TPKE
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4206
Practice Address - Country:US
Practice Address - Phone:860-268-2020
Practice Address - Fax:860-659-4358
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0002317103TC0700X
FLPY6222103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP73720Medicare UPIN
FLE8567Medicare ID - Type Unspecified