Healthcare Provider Details

I. General information

NPI: 1063506723
Provider Name (Legal Business Name): NAOMI J NEUWIRTH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 DALE RD SUITE 201
AVON CT
06001
US

IV. Provider business mailing address

40 DALE ROAD SUITE 201
AVON CT
06001
US

V. Phone/Fax

Practice location:
  • Phone: 860-676-9350
  • Fax: 860-678-7178
Mailing address:
  • Phone: 860-676-9350
  • Fax: 860-678-7178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000886
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: