Individual
JASON BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
487 CHURCH HILL RD FL 2, TRUMBULL, CT 06611-3838
(203) 400-2407
Mailing address
55 ALBERTA ST, FAIRFIELD, CT 06825-1507
(203) 400-2407
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1325
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008034442
—
CT
Enumeration date
09/04/2007
Last updated
07/29/2020
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