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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