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JASON BLACK LMFT
>> Marriage & Family Therapist >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1619161676
Individual Registrant: JASON BLACK LMFT
Gender: M
Sole Proprietor
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: --
Tel: 203-400-2407 Fax: --
Contact information for business:
55 ALBERTA ST FAIRFIELD, CT 06825-1507 US
Tel: 203-400-2407 Fax: --
Tel: 203-400-2407 Fax: --
Registration Information:
NPI: 1619161676
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 106H00000X | Behavioral Health & Social Service Providers Marriage & Family Therapist | CT | 1325 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 008034442 | CT | 05 |
