Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | ||
N | 103TH0100X | Health Service | ||
N | 103TM1800X | Intellectual & Developmental Disabilities |
NPI | 1104436096 |
---|---|
Provider Name | Gloria T Han |
First Address | New Haven, CT 06511-3789 |
Second Address | New Haven, CT 06510-2026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2020 |
Last Update Date | 05/08/2020 |