Provider Demographics
NPI:1942424189
Name:PIASETSKY, EUGENE B (PHD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:B
Last Name:PIASETSKY
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 1:2558 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3046
Mailing Address - Country:US
Mailing Address - Phone:203-230-2199
Mailing Address - Fax:203-230-2242
Practice Address - Street 1:2558 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3046
Practice Address - Country:US
Practice Address - Phone:203-230-2199
Practice Address - Fax:203-230-2242
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT01445103G00000X
NY07636103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist