Doctor Name: | DR. JEFFREY WARREN SUMMERVILLE |
NPI Number: | 1013926708 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSY.D., LCSW |
License Number: | 000823 |
Business Practice Address: | 295 Washington Avenue Suite 9 Hamden, CT - 065183025 |
Business Phone Number: | 2032878227 |
Business Fax Number: | 2032879502 |
Mailing Address: | 295 Washington Avenue, Suite 9 HAMDEN |
State: | CT |
Postal Code: | 065183025 |
Phone Number: | 2032878227 |
Fax Number: | 2032879502 |
NPI Enumeration Date: | 08/05/2006 |
NPI Last Update Date: | 02/14/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 000823 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |