Individual
JYOTHI VAYALAKKARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
152 DEMING ST, PROVIDERCARE PLUS, PC, SOUTH WINDSOR, CT 06074-3740
(860) 644-4472
(860) 644-3001
Mailing address
152 DEMING ST, PROVIDERCARE PLUS, PC, SOUTH WINDSOR, CT 06074-3740
(860) 644-4472
(860) 644-3001
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
002590
CT
103T00000X
Psychologist
Primary
002590
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060002590CT01
ANTHEM BCBS
CT
Enumeration date
11/02/2006
Last updated
09/11/2025
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