| Mr Gregory Bruce Jack, LPC | |
|
50 Academy Hill Road, Plainfield, CT 06374 | |
| (860) 564-3015 | |
| (860) 564-3025 |
| Full Name | Mr Gregory Bruce Jack |
|---|---|
| Gender | Male |
| Speciality | Mental Health Counselor |
| Experience | 49 Years |
| Location | 50 Academy Hill Road, Plainfield, Connecticut |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164517512 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 000758 (Connecticut) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Day Kimball Healthcare, Inc. | 5092773549 | 23 |
| Entity Name | Day Kimball Healthcare, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1649243478 PECOS PAC ID: 5092773549 Enrollment ID: O20041229001007 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Gregory Bruce Jack, LPC 50 Academy Hill Road, P.o. Box 201, Plainfield, CT 06374 Ph: (860) 564-3015 | Mr Gregory Bruce Jack, LPC 50 Academy Hill Road, Plainfield, CT 06374 Ph: (860) 564-3015 |
Eileen Blair, Counselor Medicare: May Accept Medicare Assignments Practice Location: 50 Academy Hill Rd, Plainfield, CT 06374 Phone: 860-564-2323 | |
Mrs. Maria A Gorby, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 50 Academy Hill Rd, Plainfield, CT 06374 Phone: 860-564-2323 Fax: 860-564-2696 | |
Laurie Elaine Deslauriers, LADC/MSW Counselor Medicare: Not Enrolled in Medicare Practice Location: 16 High Meadow Dr, Plainfield, CT 06374 Phone: 860-334-5197 | |
Gina Tourangeau, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 50 Academy Hill Rd, Plainfield, CT 06374 Phone: 860-917-9559 | |
Sylvia M Lawrence, LMSW Counselor Medicare: Not Enrolled in Medicare Practice Location: 165 Colonial Rd, Plainfield, CT 06374 Phone: 860-617-1142 | |
Mr. Andrew Demalia Jr., LCDP Counselor Medicare: Not Enrolled in Medicare Practice Location: 15 Easy St, Plainfield, CT 06374 Phone: 774-312-3881 |