| Daniel R Brockett Phd Llc | |
|
2 Pomperaug Office Park Suite 206d Southbury CT 06488-2288 | |
| (203) 264-3050 | |
| (203) 264-2426 |
| Full Name | Daniel R Brockett Phd Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 2 Pomperaug Office Park, Southbury, Connecticut |
| Authorized Official Name and Position | Daniel R. Brockett (OWNER) |
| Authorized Official Contact | 2032643050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Daniel R Brockett Phd Llc 2 Pomperaug Office Park Suite 206d Southbury CT 06488-2288 Ph: (203) 264-3050 | Daniel R Brockett Phd Llc 2 Pomperaug Office Park Suite 206d Southbury CT 06488-2288 Ph: (203) 264-3050 |
| NPI Number | 1932466547 |
|---|---|
| Provider Enumeration Date | 04/19/2012 |
| Last Update Date | 09/17/2012 |
| Medicare PECOS PAC ID | 9032367909 |
|---|---|
| Medicare Enrollment ID | O20120918000772 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932466547 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 001851 (Connecticut) | Primary |
| Provider Name | Daniel R Brockett |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801921333 PECOS PAC ID: 7517115389 Enrollment ID: I20120920000134 |
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