Doctor Name: | KENNETH ANDREW COLBY |
NPI Number: | 1063528941 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | 000474 |
Business Practice Address: | 146 Hazard Avenue Suite 206 Enfield, CT - 06082 |
Business Phone Number: | 8607633602 |
Business Fax Number: | 8607491456 |
Mailing Address: | 146 Hazard Avenue, Suite 206 ENFIELD |
State: | CT |
Postal Code: | 06082 |
Phone Number: | 8607633602 |
Fax Number: | 8607491456 |
NPI Enumeration Date: | 08/22/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 000474 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |