Individual
LISA N BACKUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
21 BUSINESS PARK DR, BRANFORD, CT 06405-2935
(203) 488-0471
Mailing address
251 WESTBROOK RD, ESSEX, CT 06426-1528
(860) 767-1277
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
PSY 4079
CO
Other
Enumeration date
09/24/2010
Last updated
09/30/2024
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