| Hartford Psychological Services, Llc | |
|
210 Wethersfield Ave Hartford CT 06114-1113 | |
| (860) 296-0094 | |
| (860) 206-1184 |
| Full Name | Hartford Psychological Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 210 Wethersfield Ave, Hartford, Connecticut |
| Authorized Official Name and Position | Rafael Mora De Jesus (DIRECTOR) |
| Authorized Official Contact | 8602960094 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hartford Psychological Services, Llc 210 Wethersfield Ave Hartford CT 06114-1113 Ph: (860) 296-0094 | Hartford Psychological Services, Llc 210 Wethersfield Ave Hartford CT 06114-1113 Ph: (860) 296-0094 |
| NPI Number | 1891989026 |
|---|---|
| Provider Enumeration Date | 08/30/2007 |
| Last Update Date | 01/26/2015 |
| Medicare PECOS PAC ID | 6406178961 |
|---|---|
| Medicare Enrollment ID | O20141211001758 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891989026 | NPI | - | NPPES |
| 004222866 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 103T00000X (Connecticut) | Primary |
| 1041C0700X | Social Worker - Clinical | 1041C0700X (Connecticut) | Secondary |
| Provider Name | Luis R Gonzalez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801863220 PECOS PAC ID: 2567350408 Enrollment ID: I20040310000888 |
| Provider Name | Leela Panoor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609802388 PECOS PAC ID: 3577454198 Enrollment ID: I20040323001104 |
| Provider Name | Andrew B Pleshkevich |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891833729 PECOS PAC ID: 5890898902 Enrollment ID: I20070310000004 |
| Provider Name | Richard Stillson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235434234 PECOS PAC ID: 5496949398 Enrollment ID: I20101104001126 |
| Provider Name | Lashanda B Harvey |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1831327816 PECOS PAC ID: 3870788573 Enrollment ID: I20101108000822 |
| Provider Name | Desreen Nichole Dudley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1841635786 PECOS PAC ID: 6305088675 Enrollment ID: I20130815000709 |
| Provider Name | Rafael B Mora De Jesus |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366503906 PECOS PAC ID: 8820137623 Enrollment ID: I20141229001271 |
| Provider Name | Juleen Mason |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700284106 PECOS PAC ID: 4183940133 Enrollment ID: I20150310000931 |
| Provider Name | Nancy E Oporto-brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992249080 PECOS PAC ID: 1254615362 Enrollment ID: I20170308001186 |
| Provider Name | Nigel Rodney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023595147 PECOS PAC ID: 3274882386 Enrollment ID: I20180823000813 |
| Provider Name | Jennifer Benjamin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821587239 PECOS PAC ID: 8820335029 Enrollment ID: I20190125001918 |
| Provider Name | Michele A Wiggins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801458716 PECOS PAC ID: 8022343888 Enrollment ID: I20190716001988 |
| Provider Name | Alicia A Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730793522 PECOS PAC ID: 9931502143 Enrollment ID: I20210726003135 |
| Provider Name | Lleidy Ivelisse De Leon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417324914 PECOS PAC ID: 0042616518 Enrollment ID: I20210908003126 |
| Provider Name | Amy Ramirez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912665803 PECOS PAC ID: 7517359847 Enrollment ID: I20220119001293 |
| Provider Name | Myrna Ivette Vargas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770724890 PECOS PAC ID: 0941686612 Enrollment ID: I20221004000448 |
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