Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 2820 | CT |
Y | 103T00000X | Psychologist | 2820 | CT |
NPI | 1003085150 |
---|---|
Provider Name | Dr. Brian T Conover |
First Address | Hartford, CT 06112-1639 |
Second Address | Hartford, CT 06112-1639 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2008 |
Last Update Date | 22/02/2008 |