Basic Information
| Provider Information | |||||||||
| NPI: | 1851771505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAVIDGE | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | THERESE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 DEERFIELD ROAD | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602700600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5904 SHERIDAN DR STE 1 | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142215873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168865493 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2015 | ||||||||
| LastUpdateDate: | 09/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 3455 | CT | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 022938 | NY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.