| Professional Resource Group PC | |
|
207 Storrs Rd # 174 Mansfield Center CT 06250-1638 | |
| (860) 456-4604 | |
| (860) 456-1738 |
| Full Name | Professional Resource Group PC |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 207 Storrs Rd # 174, Mansfield Center, Connecticut |
| Authorized Official Name and Position | Gary P Kanabay (DIRECTOR PRESIDENT) |
| Authorized Official Contact | 8604564604 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Resource Group PC 207 Storrs Rd # 174 Mansfield Center CT 06250-1638 Ph: (860) 456-4604 | Professional Resource Group PC 207 Storrs Rd # 174 Mansfield Center CT 06250-1638 Ph: (860) 456-4604 |
| NPI Number | 1710019963 |
|---|---|
| Provider Enumeration Date | 03/12/2007 |
| Last Update Date | 05/01/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710019963 | NPI | - | NPPES |
| 004398047 | Medicaid | CT | |
| 008033020 | Medicaid | CT | |
| 004255057 | Medicaid | CT | |
| C007612 | Other | TRICARE | |
| 008002985 | Medicaid | CT | |
| 297211 | Other | MHN | |
| 620000199 | Other | CT | MEDICARE |
| 004255007 | Medicaid | CT |
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