Healthcare Provider Details

I. General information

NPI: 1043495310
Provider Name (Legal Business Name): LEONARD LOUIS WYSOCKI PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 04/19/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 BROAD ST
MILFORD CT
06460-3269
US

IV. Provider business mailing address

59 LAKE RD. NARRAGANSETT R. I. 02882
NARRAGANSETT RI
02882-1003
US

V. Phone/Fax

Practice location:
  • Phone: 860-798-4913
  • Fax:
Mailing address:
  • Phone: 860-798-4913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number002834
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: