Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 001688 | CT |
Y | 103T00000X | Psychologist | 001688 | CT |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 001688 | CT |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 001688 | CT |
N | 103G00000X | Clinical Psychologist | 001688 | CT |
N | 103TC0700X | Clinical Psychologist | 001688 | CT |
N | 103TC1900X | Counseling Psychologist | 001688 | CT |
NPI | 1346590908 |
---|---|
Provider Name | Samuel Arthur Ball |
First Address | New Haven, CT 06511-5991 |
Second Address | New Haven, CT 06511-5991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2012 |
Last Update Date | 11/09/2012 |