Provider Demographics
NPI:1841399094
Name:ZLATIN, DOUGLAS I (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:I
Last Name:ZLATIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CASE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2222
Mailing Address - Country:US
Mailing Address - Phone:860-889-7274
Mailing Address - Fax:860-889-2131
Practice Address - Street 1:12 CASE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2222
Practice Address - Country:US
Practice Address - Phone:860-889-7274
Practice Address - Fax:860-889-2131
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00688103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060000688CT01OtherBLUE CROSS