| Organization Name: | STONINGTON PSYCHOLOGY LLC |
| NPI Number: | 1659627453 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LINDA SURIYAKHAM (OWNER) |
| Mailing Address: | 107 Wilcox Rd Suite 107-e Stonington |
| State: | CT US |
| Postal Code: | 063782614 |
| Phone Number: | 8602459222 |
| Fax Number: | 8605359891 |
| NPI Enumeration Date: | 07/30/2012 |
| NPI Last Update Date: | 07/30/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 003158 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |