| Black Locust Psychology Pc | |
|
29 Wickham Rd East Haddam CT 06423-1204 | |
| (203) 208-8641 | |
| Not Available |
| Full Name | Black Locust Psychology Pc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 29 Wickham Rd, East Haddam, Connecticut |
| Authorized Official Name and Position | Daniel Flack (SOLE MEMBER) |
| Authorized Official Contact | 2032088641 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Locust Psychology Pc 29 Wickham Rd East Haddam CT 06423-1204 Ph: () - | Black Locust Psychology Pc 29 Wickham Rd East Haddam CT 06423-1204 Ph: (203) 208-8641 |
| NPI Number | 1588460463 |
|---|---|
| Provider Enumeration Date | 02/21/2025 |
| Last Update Date | 02/24/2025 |
| Certification Date | 02/24/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588460463 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TF0200X | Psychologist - Forensic | (* (Not Available)) | Secondary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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