Organization
EDADVANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY KITCHING PH.D. (EXECUTIVE DIRECTOR)
(860) 567-0863
Entity
Organization
Contact information
Practice address
157 LITCHFIELD ST, TORRINGTON, CT 06790-6427
(860) 294-7473
(860) 567-3381
Mailing address
355 GOSHEN RD, LITCHFIELD, CT 06759-2404
(860) 567-0863
(860) 567-3381
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
2251P0200X
Pediatric Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Enumeration date
04/03/2012
Last updated
02/24/2017
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