Provider Demographics
NPI:1942578778
Name:EASTERN CONNECTICUT PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:EASTERN CONNECTICUT PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-886-0015
Mailing Address - Street 1:12 CASE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2222
Mailing Address - Country:US
Mailing Address - Phone:860-886-0015
Mailing Address - Fax:860-886-0015
Practice Address - Street 1:12 CASE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2222
Practice Address - Country:US
Practice Address - Phone:860-886-0015
Practice Address - Fax:860-886-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1875261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health