Provider Demographics
NPI:1487776464
Name:POULTNEY, JOAN M (PHD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:POULTNEY
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 1:279 CHEESESPRING RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-2334
Mailing Address - Country:US
Mailing Address - Phone:203-762-0034
Mailing Address - Fax:
Practice Address - Street 1:279 CHEESESPRING RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-2334
Practice Address - Country:US
Practice Address - Phone:203-762-0034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCTMFT 000389106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist