Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 000903 | CT |
Y | 103T00000X | Psychologist | 000903 | CT |
NPI | 1013943695 |
---|---|
Provider Name | Mr. Larry Michael Bilker |
First Address | Guilford, CT 06437-2147 |
Second Address | Guilford, CT 06437-2147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0600000903CT01 | ANTHEM (01) | CT |
P405018 | OXFORD (01) | CT |