Healthcare Provider Details

I. General information

NPI: 1801458716
Provider Name (Legal Business Name): MICHELE A WIGGINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 BLOOMFIELD AVE
BLOOMFIELD CT
06002-2462
US

IV. Provider business mailing address

116 ALCOTT DR
WINDSOR CT
06095-2606
US

V. Phone/Fax

Practice location:
  • Phone: 860-967-9638
  • Fax:
Mailing address:
  • Phone: 860-967-9638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005039
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: