Individual
DR. FRED E KOERNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
240 BRADLEY STREET, NEW HAVEN, CT 06510
(203) 785-8052
(203) 773-1271
Mailing address
240 BRADLEY STREET, NEW HAVEN, CT 06510
(203) 785-8052
(203) 773-1271
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
000704
CT
103TC0700X
Clinical Psychologist
Primary
000704
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680001134
MEDICARE
CT
Enumeration date
02/08/2007
Last updated
09/05/2014
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