Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 023374 | NY |
Y | 103T00000X | Psychologist | 023374 | NY |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 023374 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 023374 | NY |
N | 103G00000X | Clinical Psychologist | 023374 | NY |
N | 103TC0700X | Clinical Psychologist | 023374 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 023374 | NY |
N | 103TF0000X | Family Psychologist | 023374 | NY |
N | 103TP2701X | Group Psychotherapist | 023374 | NY |
NPI | 1164065777 |
---|---|
Provider Name | Dr. Patricia Simon |
First Address | New Haven, CT 06511-2301 |
Second Address | New Haven, CT 06511-2301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2019 |
Last Update Date | 18/02/2021 |