Individual
DR. JACK JURICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15 BRAEBURN RD, WEST HARTFORD, CT 06107-1605
(212) 255-6632
Mailing address
15 BRAEBURN RD, WEST HARTFORD, CT 06107-1605
(212) 255-6632
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
014799
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02161493
—
NY
Enumeration date
10/24/2007
Last updated
07/26/2024
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