Black, Jason

Black, Jason is an sole proprietor health care provider with primary practice located at 487 Church Hill Rd Fl 2 , Trumbull CT 06611-3838. He recently has only one registered license in Behavioral Health & Social Service Providers / Marriage & Family Therapist, which is considered as his primary health care specialty. Black, Jason can be contacted via phone (203) 400-2407.

Contact Information

Primary practice address
487 Church Hill Rd Fl 2 Trumbull CT 06611-3838
Phone: (203) 400-2407
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 1325 Connecticut

Profile Details

NPI number 1619161676
LBN Legal business name Black, Jason
Credentials LMFT
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 4th, 2007
Last updated Jul 29th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619161676 NPPES
Connecticut MEDICAID 008034442

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