Facts
- Status
- A
- Credential
- LCSW
- Type
- Individual
- Enumeration date
- 2020-12-22
- Last updated
- 2021-02-12
Specialties
Licenses
- License CT
- 11290
Location
- Practice location
- 16 HILLSIDE AVE
- City
- NAUGATUCK CT
- Postal code
- 067704019
- Phone
- 203-718-6383
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.