Organization
PEDIATRIC PSYCHOLOGY OF CONNECTICUT, LLC
Active
Organization
PEDIATRIC PSYCHOLOGY OF CONNECTICUT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK VINCENT GRUDBERG PH.D. (MEMBER)
(888) 342-6002
Entity
Organization
Contact information
Practice address
413 ORANGE ST, SUITE 1, NEW HAVEN, CT 06511-6424
(888) 342-6002
(347) 344-6594
Mailing address
PO BOX 4098, WOODBRIDGE, CT 06525-0298
(888) 342-6002
(347) 344-6594
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3139
CT
Other
Enumeration date
04/09/2012
Last updated
04/09/2012
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