Healthcare Provider Details

I. General information

NPI: 1952233587
Provider Name (Legal Business Name): REPAIRER ETUK OKON ETUK PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LONG WHARF DR
NEW HAVEN CT
06511-5991
US

IV. Provider business mailing address

1 CHURCH ST FL 7
NEW HAVEN CT
06510-3330
US

V. Phone/Fax

Practice location:
  • Phone: 203-974-5781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: