Provider Demographics
NPI:1336255355
Name:STABLEFORD, WILLIAM K (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:K
Last Name:STABLEFORD
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 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2603
Mailing Address - Country:US
Mailing Address - Phone:203-453-5235
Mailing Address - Fax:203-453-6204
Practice Address - Street 1:152 BROAD ST
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2603
Practice Address - Country:US
Practice Address - Phone:203-453-5235
Practice Address - Fax:203-453-6204
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1047103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical