INTEGRATIVE PSYCHOLOGICAL CENTER LLC (NPI# 1306318670) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306318670 |
| Entity Type | Organization |
| Organization Name | INTEGRATIVE PSYCHOLOGICAL CENTER LLC |
| Practice Address |
44 Capitol Ave Ste 402 Hartford CT 06106-1764 |
| Mailing Address |
40 Mountain Rd West Hartford CT 06107-2913 |
| Practice Telephone | 8604669411 |
| Mailing Telephone | 8604669411 |
| Enumeration Date | 2018-12-26 |
| Last Update Date | 2018-12-26 |
| Authorized Official Name | DR. RANDALL WALLACE (OWNER/PSYCHOLOGIST) |
| Authorized Official Telephone | 8604669411 |
| Authorized Official Credential | PSYD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 103TF0200X |
Psychologist Specialization: Forensic |
Behavioral Health & Social Service Providers | ||
| Y | 103T00000X | Psychologist | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 008042490 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | INTEGRATIVE PSYCHOLOGICAL CENTER LLC | 44 Capitol Ave, Hartford, CT 06106 |
| Street Address |
44 CAPITOL AVE STE 402 |
| City | HARTFORD |
| State | CT |
| Zip Code | 06106-1764 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750907325 | Vartika Kesarwani | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care-brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2020-06-19 |
| 1720602865 | Meher Kaur Singha | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care- Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2020-06-04 |
| 1497314140 | Eduardo Mantovani Cardoso | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adut Primary Care - Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2019-06-06 |
| 1114582178 | Dimitrios Drekolias | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care - Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2019-05-06 |
| 1316501687 | Rafae Shaikh | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2019-04-23 |
| 1437643715 | Lucas Bensa | Social Worker | 421 Washington St., Apt C1, Hartford, CT 06106 | 2018-06-19 |
| 1548754310 | Collin Dimler | Physician Assistant | 85 Seymour St Ste 1003, Hartford, CT 06106 | 2018-06-15 |
| 1619460581 | Bryan F Stringer | Student in an Organized Health Care Education/Training Program | 79 Retreat Ave., Hh-adult Primary Care - Brown Stone, Hartford, CT 06106 | 2018-06-14 |
| 1083103972 | Margret Sigurdardottir Blondal | Student in an Organized Health Care Education/Training Program | 282 Washington Street, Ste 4h, Hartford, CT 06106 | 2018-05-07 |
| 1265920995 | Rudra Ramanathan | Student in an Organized Health Care Education/Training Program | 79 Retreat Ave Brown Stone, Hartford, CT 06106 | 2018-04-27 |
| Find all providers in zip 06106 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386078442 | Rocio Chang-angulo | Psychologist | 2074 Park St Ste 203, Hartford, CT 06106-2060 | 2013-08-26 |
| 1366503906 | Rafael Mora De Jesus | Psychologist | 210 Wethersfield Ave, Hartford, CT 06114-1113 | 2006-12-13 |
| 1679632525 | Michael David Kahn | Psychologist | 660 Prospect Avenue, Hartford, CT 06105 | 2006-12-07 |
| 1609946581 | Deborah Ann Doherty | Psychologist | 639 Prospect Ave, Hartford, CT 06105-4276 | 2006-11-08 |
| 1023195864 | Deborah Jean Stack | Psychologist | 682 Prospect Avenue, Hartford, CT 06105 | 2006-11-01 |
| 1386661841 | Elizabeth Leah Vitale | Psychologist | 682 Prospect Ave., Hartford, CT 06105-4238 | 2006-07-17 |
| 1922074343 | Kimberly M. Daniels | Psychologist | 682 Prospect Ave, Hartford, CT 06105-4238 | 2006-02-25 |
| 1245866623 | Rachel Tirnady | Psychologist | 76 New Britain Ave, Hartford, CT 06106-3305 | 2020-03-18 |
| 1427696202 | Kimberly M Daniels LLC | Psychologist | 682 Prospect Ave, Hartford, CT 06105-4238 | 2019-12-12 |
| 1235784372 | Kimberly Toby Stevens | Psychologist | 200 Retreat Ave, Hartford, CT 06114 | 2019-08-06 |
| Find all providers in HARTFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.