Healthcare Provider Details

I. General information

NPI: 1952540528
Provider Name (Legal Business Name): CARI LAUREN MEDWIN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 WOODS RD
BETHANY CT
06524-3103
US

IV. Provider business mailing address

15 WOODS RD.
BETHNY CT
06524
US

V. Phone/Fax

Practice location:
  • Phone: 203-891-6937
  • Fax:
Mailing address:
  • Phone: 203-891-6937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberRO31144
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: