Doctor Name: | STACY ELLEN CRUESS |
NPI Number: | 1063511681 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | 002704 |
Business Practice Address: | 189 Storrs Rd Natchaug Hospital Mansfield Center, CT - 062501683 |
Business Phone Number: | 8604561311 |
Business Fax Number: | 8604560164 |
Mailing Address: | 189 Storrs Rd, Natchaug Hospital MANSFIELD CENTER |
State: | CT |
Postal Code: | 062501683 |
Phone Number: | 8604561311 |
Fax Number: | 8604560164 |
NPI Enumeration Date: | 09/21/2006 |
NPI Last Update Date: | 12/30/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 002704 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |