| Doctor Name: | PATRCIK WILLIAM FALLON |
| NPI Number: | 1043585474 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CAC |
| License Number: | 4666 |
| Business Practice Address: | 176 State St Meriden, CT - 064503242 |
| Business Phone Number: | 2036301568 |
| Business Fax Number: | 2036300698 |
| Mailing Address: | 205 Orange St, NEW HAVEN |
| State: | CT |
| Postal Code: | 065102069 |
| Phone Number: | 2037769900 |
| Fax Number: | 2037875599 |
| NPI Enumeration Date: | 03/19/2012 |
| NPI Last Update Date: | 03/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 4666 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |