Provider Demographics
NPI:1740339506
Name:SMALLER, ADRIENNE G (PHD)
Entity type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:G
Last Name:SMALLER
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 1:588 BOSTON POST RD
Mailing Address - Street 2:SUITE EAST
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2050
Mailing Address - Country:US
Mailing Address - Phone:203-245-0062
Mailing Address - Fax:
Practice Address - Street 1:588 BOSTON POST RD
Practice Address - Street 2:SUITE EAST
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3121
Practice Address - Country:US
Practice Address - Phone:203-245-0638
Practice Address - Fax:203-245-9446
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002272103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical