Healthcare Provider Details

I. General information

NPI: 1184925919
Provider Name (Legal Business Name): LORETTA J. MUNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MIDDLE ST
BRISTOL CT
06010-7404
US

IV. Provider business mailing address

123 MIDDLE ST
BRISTOL CT
06010-7404
US

V. Phone/Fax

Practice location:
  • Phone: 860-281-2280
  • Fax: 860-499-3514
Mailing address:
  • Phone: 860-281-2280
  • Fax: 860-499-3514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number008330
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: