| Organization Name: | CONNECTICUT GERIATRIC PSYCHOLOGICAL SERVICES, PC |
| NPI Number: | 1124340203 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TIMOTHY W. WELLES (PRESIDENT) |
| Mailing Address: | 112 Betsy Brown Rd Port Chester |
| State: | NY US |
| Postal Code: | 105732231 |
| Phone Number: | 9149376174 |
| Fax Number: | 9149376174 |
| NPI Enumeration Date: | 02/17/2010 |
| NPI Last Update Date: | 10/27/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TA0700X |
| License Number: | 2657 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Adult Development & Aging |
| Taxonomy Definition: | |