| Doctor Name: | KENT SUNDERLAND |
| NPI Number: | 1003263245 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSYD |
| License Number: | 3559 |
| Business Practice Address: | 675 Main Street Middletown, CT - 064572632 |
| Business Phone Number: | 8603476971 |
| Business Fax Number: | 8607048034 |
| Mailing Address: | 675 Main Street, MIDDLETOWN |
| State: | CT |
| Postal Code: | 064572632 |
| Phone Number: | 8603476971 |
| Fax Number: | 8607048034 |
| NPI Enumeration Date: | 05/18/2016 |
| NPI Last Update Date: | 05/18/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 3559 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |