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General NPI Number Information
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NPI Number | 1205140803
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Entity Type | Individual
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Provider Name | JASON ALAN GOCKEL PSY.D
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Gender | Male
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Dates
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Enumeration Date | 08/06/2010
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 41 S MAIN ST STE 7
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2448
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Country | US
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Telephone | 860-904-8925
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Fax |
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Provider Business Mailing Address
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Address Line | 41 SOUTH MAIN ST SUITE 7
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City | WEST HARTFORD
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State | CT
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Zip | 06107
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Country | US
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Telephone | 860-904-8925
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 003611
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License Number State | CT
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