Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 002894 | CT |
Y | 103TC0700X | Clinical Psychologist | 002894 | CT |
NPI | 1003049354 |
---|---|
Provider Name | Dr. Ellen Preen |
First Address | Avon, CT 06001-3692 |
Second Address | Avon, CT 06001-3692 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2009 |
Last Update Date | 02/09/2009 |