Provider Demographics
NPI:1245449735
Name:BRONSON, NANCY L (PHD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:L
Last Name:BRONSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 HAVILAND CT
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-3331
Mailing Address - Country:US
Mailing Address - Phone:203-329-0005
Mailing Address - Fax:203-329-2022
Practice Address - Street 1:76 HAVILAND CT
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06903-3331
Practice Address - Country:US
Practice Address - Phone:203-329-0005
Practice Address - Fax:203-329-2022
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1086103TC0700X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060001086CT01Medicare UPIN
CT107623Medicare UPIN