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Individual

MICHAEL ANDREW WIDROFF

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1 WAHOO AVE, GROTON, CT 06349-2324
(860) 694-4966
Mailing address
920 E 17TH ST, APARTMENT 606, BROOKLYN, NY 11230-3751
(917) 402-0360

Taxonomy

Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
12/10/2015
Last updated
04/12/2018
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