Provider Demographics
NPI:1912393844
Name:LACKI, ELLIOTT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:
Last Name:LACKI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 ALLEN PL
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-3162
Mailing Address - Country:US
Mailing Address - Phone:518-578-0992
Mailing Address - Fax:
Practice Address - Street 1:135 ALLEN PL
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3162
Practice Address - Country:US
Practice Address - Phone:860-297-2415
Practice Address - Fax:860-297-2428
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2023-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3804103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical