Healthcare Provider Details

I. General information

NPI: 1649789017
Provider Name (Legal Business Name): JOHN SYC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CREST DR
CROMWELL CT
06416-2047
US

IV. Provider business mailing address

14 CREST DR
CROMWELL CT
06416-2047
US

V. Phone/Fax

Practice location:
  • Phone: 860-704-9153
  • Fax:
Mailing address:
  • Phone: 860-704-9153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7946
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOHN ANTHONY SYC
Title or Position: MANAGING MEMBER
Credential: LCSW
Phone: 860-704-9153