Basic Information
| Provider Information | |||||||||
| NPI: | 1447545231 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE PSYCHOLOGICAL & ASSESSMENT SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 TOWN LINE RD | ||||||||
| Address2: | SUITE #101 | ||||||||
| City: | WETHERSFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061094352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607573702 | ||||||||
| FaxNumber: | 8607573725 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 TOWN LINE RD | ||||||||
| Address2: | SUITE #101 | ||||||||
| City: | WETHERSFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061094352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607573702 | ||||||||
| FaxNumber: | 8607573725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2011 | ||||||||
| LastUpdateDate: | 02/29/2012 | ||||||||
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| AuthorizedOfficialLastName: | HERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | MARGARITA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PSYCHOLOGIST/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8607573702 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | P.H.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 103TP0814X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Psychoanalysis | 103TP2701X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | 103TC0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 002171 | 01 | CT | LICENSE | OTHER |