Healthcare Provider Details

I. General information

NPI: 1376897009
Provider Name (Legal Business Name): JOSEPH SISK MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROSCOMMON DR
MIDDLETOWN CT
06457-1591
US

IV. Provider business mailing address

205 ORANGE ST
NEW HAVEN CT
06510-2069
US

V. Phone/Fax

Practice location:
  • Phone: 860-344-0682
  • Fax: 860-344-1571
Mailing address:
  • Phone: 203-776-9900
  • Fax: 203-787-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number000726
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: