Provider Demographics
NPI:1528172269
Name:FEHON, DWAIN CLARK (PSYD)
Entity type:Individual
Prefix:DR
First Name:DWAIN
Middle Name:CLARK
Last Name:FEHON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:184 LIBERTY ST
Mailing Address - Street 2:YALE-NEW HAVEN PSYCHIATRIC HOSPITAL
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1625
Mailing Address - Country:US
Mailing Address - Phone:203-688-9779
Mailing Address - Fax:203-688-9709
Practice Address - Street 1:184 LIBERTY ST
Practice Address - Street 2:YALE-NEW HAVEN PSYCHIATRIC HOSPITAL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1625
Practice Address - Country:US
Practice Address - Phone:203-688-9779
Practice Address - Fax:203-688-9709
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT001906103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical