Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 001889 | CT |
NPI | 1023069648 |
---|---|
Provider Name | Michele Anne Goyette -Ewing |
First Address | New Haven, CT 06511-6624 |
Second Address | New Haven, CT 06519-1369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 25/09/2007 |