Healthcare Provider Details

I. General information

NPI: 1730596826
Provider Name (Legal Business Name): SASHA MARISSA GELBAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 ROBERT FROST DR
BRANFORD CT
06405-5838
US

IV. Provider business mailing address

705 ROBERT FROST DR
BRANFORD CT
06405-5838
US

V. Phone/Fax

Practice location:
  • Phone: 203-668-4628
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8694
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: