Provider Demographics
NPI:1437218823
Name:VAN SAMBECK, WALTER (DIPL PSYCH)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:
Last Name:VAN SAMBECK
Suffix:
Gender:M
Credentials:DIPL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1405
Mailing Address - Country:US
Mailing Address - Phone:860-537-3977
Mailing Address - Fax:
Practice Address - Street 1:244 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1405
Practice Address - Country:US
Practice Address - Phone:860-537-3977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000462101YA0400X
CT000493101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT300000462CT01OtherBLUE CROSS BLUE SHIELD