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General NPI Number Information
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NPI Number | 1598363962
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Entity Type | Organization
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Legal Business Name | TYREK J PRATT LLC
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Dates
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Enumeration Date | 10/16/2020
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 74 NEW LONDON TPKE STE 1
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City | GLASTONBURY
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State | CT
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Zip | 06033-4204
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Country | US
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Telephone | 860-365-1310
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Fax |
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Provider Business Mailing Address
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Address Line | 74 NEW LONDON TPKE STE 1
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City | GLASTONBURY
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State | CT
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Zip | 06033-4204
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Country | US
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Telephone | 860-365-1310
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Fax |
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Authorized Official
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Title or Position | OWNER / PSYCHOLOGIST
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Name | MR. TYREK J PRATT
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Credential | PSYCHOLOGIST
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Telephone | 860-365-1310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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