Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 6301015521 | MI |
N | 103T00000X | Psychologist | 6301015521 | MI |
Y | 103G00000X | Clinical Psychologist | 3515 | CT |
Y | 103TC0700X | Clinical Psychologist | 3515 | CT |
NPI | 1003255274 |
---|---|
Provider Name | Chelsea Mcintosh |
First Address | Stamford, CT 06902-5113 |
Second Address | Stamford, CT 06902-5113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2013 |
Last Update Date | 01/04/2016 |