Louis Joseph Destefano, PHD
Individual provider Active NPI Clinical Psychologist · Ansonia, CT
NPI 1891703187 · NPPES record last updated Dec 19, 2012
Key facts
- NPI
- 1891703187
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 01097 (CT)
- Practice address
- 203 Wakelee Ave
Ansonia, CT 06401-1234 - Phone
- (203) 735-7481
- NPI assigned
- Aug 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01097 | CT | MD | Clinical Psychologist |
| 001097 | CT | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Catholic Charities, Inc. - Archdiocese of Hartford | Past | Accepting new patients | |
| Rushford Center, Inc. | Clinical | Past | Accepting new patients |
| Catholic Charities, Inc. - Archdiocese of Hartford | Past |
Accepting new patients |
Interoperability endpoints
- https://api.qualifacts.org/api/fhir/ccaoh/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 01097 | CT | Yes |
Addresses
Primary practice location
203 Wakelee Ave
Ansonia, CT 06401-1234
Mailing address
205 Wakelee Ave
Ansonia, CT 06401-1234
Phone (203) 735-7481
Other providers in Ansonia, CT
- Douglas C Curtiss
- David D. Millen, D.M.D. PC
- Suzanne M Deluca
- Diasha Denby
- Michael G Deotte
- Lauren Brooke Dibenedetto
- Nicole Maria Dimatteo
- Marie Dimeglio
- Danielle Dixon
- Dr Robert L Lerman
All providers in Ansonia, CT · Clinical Psychologist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.