Provider Demographics
NPI:1154009884
Name:AGUESSY, BIDOSSESSI(BIDO) E (PSYD)
Entity type:Individual
Prefix:DR
First Name:BIDOSSESSI(BIDO)
Middle Name:E
Last Name:AGUESSY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 NEW PARK AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2174
Mailing Address - Country:US
Mailing Address - Phone:973-873-3933
Mailing Address - Fax:
Practice Address - Street 1:151 NEW PARK AVE STE 120
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2174
Practice Address - Country:US
Practice Address - Phone:973-873-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6486103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty