Provider Demographics
NPI:1013943695
Name:BILKER, LARRY MICHAEL (PHD)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:MICHAEL
Last Name:BILKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:
Other - Last Name:BILKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD LLC
Mailing Address - Street 1:296 VALLEY SHORES DRIVE
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2147
Mailing Address - Country:US
Mailing Address - Phone:203-453-0263
Mailing Address - Fax:
Practice Address - Street 1:296 VALLEY SHORES DRIVE
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2147
Practice Address - Country:US
Practice Address - Phone:203-453-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000903103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0600000903CT01OtherANTHEM
CTP405018OtherOXFORD