Provider Demographics
NPI:1811982655
Name:STALTARO, PERRY A (PSYD)
Entity type:Individual
Prefix:DR
First Name:PERRY
Middle Name:A
Last Name:STALTARO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1518
Mailing Address - Country:US
Mailing Address - Phone:860-502-4908
Mailing Address - Fax:860-502-4908
Practice Address - Street 1:2 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1518
Practice Address - Country:US
Practice Address - Phone:860-502-4908
Practice Address - Fax:860-513-4828
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2024-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
CT2734103TC0700X, 103TC2200X, 103TF0000X, 103TF0200X, 103TM1800X, 103TP2701X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy