Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 3559 | CT |
Y | 103TC0700X | Clinical Psychologist | 3559 | CT |
NPI | 1003263245 |
---|---|
Provider Name | Kent Sunderland |
First Address | Middletown, CT 06457-2632 |
Second Address | Middletown, CT 06457-2632 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2016 |
Last Update Date | 18/05/2016 |