Healthcare Provider Details

I. General information

NPI: 1699207803
Provider Name (Legal Business Name): ESTHER MWANGI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 JEROME AVE SUITE 218
BLOOMFIELD CT
06002-2463
US

IV. Provider business mailing address

5 MICHELLE LN
WINDSOR CT
06095-1680
US

V. Phone/Fax

Practice location:
  • Phone: 860-205-2157
  • Fax: 860-285-8285
Mailing address:
  • Phone: 860-205-2157
  • Fax: 860-285-8287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9759
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: