Individual
DAVID SHACK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
270 FARMINGTON AVE, SUITE 309, FARMINGTON, CT 06032-1909
(860) 677-5570
Mailing address
8 MAGNOLIA CIR, FARMINGTON, CT 06032-2049
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
646
CT
Other
Enumeration date
05/23/2006
Last updated
07/08/2007
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