Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 0002317 | CT |
N | 103TC0700X | Clinical Psychologist | 0002317 | CT |
Y | 103G00000X | Clinical Psychologist | PY6222 | FL |
Y | 103TC0700X | Clinical Psychologist | PY6222 | FL |
NPI | 1013084672 |
---|---|
Provider Name | Dr. James M. Conti |
First Address | Glastonbury, CT 06033-0423 |
Second Address | Glastonbury, CT 06033-4206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 14/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P73720 | (02) | FL |