Individual
WESLEY L VINCENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
139 HAZARD AVE, SUITE 7, ENFIELD, CT 06082-4597
(860) 763-4465
(860) 763-4467
Mailing address
206 BOSTON TPKE, POMFRET CENTER, CT 06259-9514
(860) 974-2994
(860) 974-2994
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
001556
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004134459
—
CT
Enumeration date
06/27/2006
Last updated
10/26/2012
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