Healthcare Provider Details

I. General information

NPI: 1104910801
Provider Name (Legal Business Name): LAUREN A VERNAGLIA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 BLOOMFIELD AVE
BLOOMFIELD CT
06002-2489
US

IV. Provider business mailing address

79 BEECHWOOD LANE
BRISTOL CT
06010
US

V. Phone/Fax

Practice location:
  • Phone: 860-243-6584
  • Fax: 860-243-6591
Mailing address:
  • Phone: 860-585-5459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number006123
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: