Individual
ROY NISENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD MDIV
Contact information
Practice address
28 ACADEMY ST, NEW HAVEN, CT 06511-6930
(203) 497-8320
Mailing address
28 ACADEMY ST, NEW HAVEN, CT 06511-6930
(203) 497-8320
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
00678
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018704
HEALTHNET
—
01
—
060000678CT05
ANTHEM
CT
01
—
108432
VALUE OPTIONS
—
01
—
ZS381
OXFORD
—
Enumeration date
08/11/2006
Last updated
07/08/2007
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