Provider Demographics
NPI:1194478792
Name:CYRIL, KHADIJAH NELLY (PHD)
Entity type:Individual
Prefix:DR
First Name:KHADIJAH
Middle Name:NELLY
Last Name:CYRIL
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 1:680 E MAIN ST # 621
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-2113
Mailing Address - Country:US
Mailing Address - Phone:203-772-8958
Mailing Address - Fax:
Practice Address - Street 1:275 CIRCULAR AVE APT 1C
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-4047
Practice Address - Country:US
Practice Address - Phone:203-671-0171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4166103T00000X
NY024546103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist