Provider Demographics
NPI:1295595445
Name:MENCIO, TY CHRISTOPHER
Entity type:Individual
Prefix:
First Name:TY
Middle Name:CHRISTOPHER
Last Name:MENCIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SUNNY LN APT D
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3534
Mailing Address - Country:US
Mailing Address - Phone:203-600-4032
Mailing Address - Fax:
Practice Address - Street 1:113 SUNNY LN APT D
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3534
Practice Address - Country:US
Practice Address - Phone:203-600-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician