Provider Demographics
NPI:1952910192
Name:PRATT, TYREK J (PSYD)
Entity Type:Individual
Prefix:PROF
First Name:TYREK
Middle Name:J
Last Name:PRATT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:PROF
Other - First Name:TYREK
Other - Middle Name:J
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:41B NEW LONDON TPKE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4240
Mailing Address - Country:US
Mailing Address - Phone:860-389-1256
Mailing Address - Fax:
Practice Address - Street 1:74 NEW LONDON TPKE STE 1
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4204
Practice Address - Country:US
Practice Address - Phone:860-389-1256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YM0800X, 103TC1900X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty