Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 003121 | CT |
Y | 103T00000X | Psychologist | 003121 | CT |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103G00000X | Clinical Psychologist | 003121 | CT |
N | 103TC0700X | Clinical Psychologist | 003121 | CT |
NPI | 1568704104 |
---|---|
Provider Name | Brian D Kiluk |
First Address | New Haven, CT 06511-5991 |
Second Address | New Haven, CT 06511-5991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2013 |
Last Update Date | 21/03/2013 |