Individual
DR. JACK THAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
300 HEBRON AVE, SUITE 217 COUNSELING AFFILIATES INC MEDICAL ARTS CENTER, GLASTONBURY, CT 06033
(860) 659-2697
(860) 659-3468
Mailing address
300 HEBRON AVE, SUITE 217 COUNSELING AFFILIATES INC MEDICAL ARTS CENTER, GLASTONBURY, CT 06033
(860) 659-2697
(860) 659-3468
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
001266
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0600011266001
ANTHEM BC
CT
01
—
134309
VALUE OPTIONS UBH
CT
01
—
P2743373
OXFORD
CT
Enumeration date
02/28/2007
Last updated
07/08/2007
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