Individual
MR. JONATHAN A. LUYSTERBORGHS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.C.S.W.
Contact information
Practice address
635 MAIN ST, MIDDLETOWN, CT 06457-2718
(860) 347-6971
(860) 638-6601
Mailing address
635 MAIN ST, MIDDLETOWN, CT 06457-2718
(860) 347-6971
(860) 638-6601
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
004330
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
191056
MANAGED HEALTH NETWORK
CT
01
—
382736
VALUEOPTIONS
CT
Enumeration date
04/26/2006
Last updated
07/08/2007
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