Individual
DR. LISA JANE BACKUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
129 TOLLAND STAGE RD, SUITE 1, TOLLAND, CT 06084-2342
(860) 454-0611
(860) 454-0919
Mailing address
PO BOX 537, WILLINGTON, CT 06279-0537
(860) 837-4995
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
003187
CT
Other
Enumeration date
11/15/2012
Last updated
10/03/2014
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