Thaw, Jack

Thaw, Jack is an individual health care provider with primary practice located at 300 Hebron Ave Suite 217 Counseling Affiliates Inc Medical Arts Center, Glastonbury CT 06033. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Thaw, Jack can be contacted via phone (860) 659-2697.

Contact Information

Primary practice address
300 Hebron Ave Suite 217 Counseling Affiliates Inc Medical Arts Center Glastonbury CT 06033
Phone: (860) 659-2697
Fax: (860) 659-3468
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 001266 Connecticut

Profile Details

NPI number 1801923586
LBN Legal business name Thaw, Jack
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 28th, 2007
Last updated Jul 8th, 2007 - about 17 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 1801923586 NPPES
Connecticut Other 0600011266001 ANTHEM BC
Connecticut Other P2743373 ANTHEM BC
Connecticut Other 134309 ANTHEM BC

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