Organization
HARTFORD PSYCHOLOGICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAFAEL MORA DE JESUS PH.D. (DIRECTOR)
(860) 296-0094
Entity
Organization
Contact information
Practice address
210 WETHERSFIELD AVE, HARTFORD, CT 06114-1113
(860) 296-0094
(860) 206-1184
Mailing address
210 WETHERSFIELD AVE, HARTFORD, CT 06114-1113
(860) 296-0094
(860) 206-1184
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
103T00000X
CT
1041C0700X
Clinical Social Worker
1041C0700X
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004222866
—
CT
Enumeration date
08/30/2007
Last updated
01/26/2015
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