Provider Demographics
NPI:1184776593
Name:GLASTONBURY PSYCHOLOGICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:GLASTONBURY PSYCHOLOGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAGNAVITA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-659-1202
Mailing Address - Street 1:300 HEBRON AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2176
Mailing Address - Country:US
Mailing Address - Phone:860-659-1202
Mailing Address - Fax:860-657-1535
Practice Address - Street 1:300 HEBRON AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2176
Practice Address - Country:US
Practice Address - Phone:860-659-1202
Practice Address - Fax:860-657-1535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1008103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty