Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
Y | 103TC1900X | Counseling Psychologist | 002834 | CT |
NPI | 1043495310 |
---|---|
Provider Name | Dr. Leonard Louis Wysocki |
First Address | Marlborough, CT 06447-1003 |
Second Address | Marlborough, CT 06447-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2008 |
Last Update Date | 07/01/2008 |