Provider Demographics
NPI:1710029210
Name:HALBROOK, JOHN H (EDD, LCSW, MFT)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:HALBROOK
Suffix:
Gender:M
Credentials:EDD, LCSW, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 FRIENDLEE LN
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-3109
Mailing Address - Country:US
Mailing Address - Phone:203-762-3106
Mailing Address - Fax:203-762-3106
Practice Address - Street 1:410 W 40TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-1204
Practice Address - Country:US
Practice Address - Phone:212-358-1317
Practice Address - Fax:203-762-3106
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0479401041C0700X
CT0043621041C0700X
CT000546106H00000X
NY000035106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10743237OtherCAQH ID # FOR CREDENTIAL
NYP2542770OtherOXFORD INS. PROVIDER NO.
NYN3I831Medicare ID - Type UnspecifiedMEDICARE #
NY10743237OtherCAQH ID # FOR CREDENTIAL