Dr. Scuddy Fontenelle IV
Psychologist, Clinical in New Haven, CT. Individual provider (NPI-1).
NPI number1124428313
StatusActive
Last updated in NPPESMar 8, 2017
Details
- NPI
- 1124428313
- Entity type
- Individual (NPI-1)
- Name
- Dr. Scuddy Fontenelle IV
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 26, 2014
- Last updated
- Mar 8, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TC0700X | Psychologist, Clinical | 3574 | CT | Yes |
Practice location
40 Temple St Ste 7dNew Haven, CT 06510-2715
Phone 203-785-6115
Mailing address
40 Temple St Ste 7dNew Haven, CT 06510-2715
Phone 203-785-6115
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