Provider Demographics
NPI:1396258786
Name:PSYCHOLOGICAL ASSOCIATES OF CHESHIRE, LLC
Entity type:Organization
Organization Name:PSYCHOLOGICAL ASSOCIATES OF CHESHIRE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JARAMILLO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:203-272-6804
Mailing Address - Street 1:290 HIGHLAND AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2564
Mailing Address - Country:US
Mailing Address - Phone:203-272-6804
Mailing Address - Fax:
Practice Address - Street 1:290 HIGHLAND AVE STE 2
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2564
Practice Address - Country:US
Practice Address - Phone:203-272-6804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245600451OtherNPI
1033402086OtherNPI
1588174262OtherNPI