Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 000931 | CT |
NPI | 1508138652 |
---|---|
Provider Name | Mr. Richard Austin JR. |
First Address | New Haven, CT 06511-3072 |
Second Address | Hartford, CT 06120-2508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2012 |
Last Update Date | 06/02/2012 |