Provider Demographics
NPI:1669584074
Name:CHINSKY, JACK M (PHD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:M
Last Name:CHINSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 ELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3515
Mailing Address - Country:US
Mailing Address - Phone:860-289-4404
Mailing Address - Fax:860-289-4401
Practice Address - Street 1:1169 ELLINGTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3515
Practice Address - Country:US
Practice Address - Phone:860-289-4404
Practice Address - Fax:860-289-4401
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000461103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical