Individual
BRIAN WASICEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-1410
(860) 679-4733
Mailing address
263 FARMINGTON AVE, FARMINGTON, CT 06030-1410
(860) 679-4733
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
72791
CT
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/06/2020
Last updated
11/10/2022
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