Individual
VITALIY TROYAKOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
576 STATE ST, SPRINGFIELD, MA 01109-4104
(413) 781-6485
Mailing address
576 STATE ST, SPRINGFIELD, MA 01109-4104
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110028012/A
—
MA
Enumeration date
09/16/2014
Last updated
09/16/2014
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