Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3209 | CT |
Y | 103T00000X | Psychologist | 3209 | CT |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 3209 | CT |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3209 | CT |
N | 103G00000X | Clinical Psychologist | 3209 | CT |
N | 103TC0700X | Clinical Psychologist | 3209 | CT |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 3209 | CT |
N | 103TF0000X | Family Psychologist | 3209 | CT |
NPI | 1437434917 |
---|---|
Provider Name | Dr. Xoli Redmond |
First Address | New Haven, CT 06511-6402 |
Second Address | New Haven, CT 06511-6402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2011 |
Last Update Date | 04/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004235918 | (05) | CT |