Organization
CLINICAL BRIDGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN F. MICHAELIS PH.D. (PRESIDENT)
(203) 216-2036
Entity
Organization
Contact information
Practice address
209 MAIN ST, SOUTHINGTON, CT 06489-2539
(203) 216-2036
Mailing address
209 MAIN ST, SOUTHINGTON, CT 06489-2539
(203) 216-2036
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
001477
CT
103TC2200X
Clinical Child & Adolescent Psychologist
001477
CT
Other
Enumeration date
09/29/2009
Last updated
09/29/2009
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