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Contact Information

BLACK LOCUST PSYCHOLOGY PC
29 WICKHAM RD
EAST HADDAM, CT06423-1204
 Phone: 203-208-8641
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
 

Forensic

103TF0200X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for BLACK LOCUST PSYCHOLOGY PC

NPI # 1588460463
LBN Legal business name BLACK LOCUST PSYCHOLOGY PC
Authorized official DANIEL FLACK - (SOLE MEMBER)
Entity Organization
Organization subpart 1 No
Enumeration date 02/21/2025
Last updated 02/24/2025 - More than a year ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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