Provider Demographics
NPI:1205140803
Name:GOCKEL, JASON ALAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALAN
Last Name:GOCKEL
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 1:41 SOUTH MAIN ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107
Mailing Address - Country:US
Mailing Address - Phone:860-904-8925
Mailing Address - Fax:
Practice Address - Street 1:41 S MAIN ST STE 7
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2448
Practice Address - Country:US
Practice Address - Phone:860-904-8925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003611103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003611OtherLICENSE NUMBER