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JASON BLACK LMFT

>> Marriage & Family Therapist >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1619161676

Individual Registrant:
 JASON  BLACK LMFT
Gender: M
Sole Proprietor

Location and contact information for practice:
487 CHURCH HILL RD FL 2  TRUMBULL, CT 06611-3838 US
Tel: 203-400-2407  Fax: --

Contact information for business:
55 ALBERTA ST  FAIRFIELD, CT 06825-1507 US
Tel: 203-400-2407  Fax: --

Registration Information:
NPI: 1619161676
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y106H00000XBehavioral Health & Social Service Providers
Marriage & Family Therapist
CT1325

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
008034442CT05




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