Healthcare Provider Details

I. General information

NPI: 1619044369
Provider Name (Legal Business Name): MARY ANN KEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 ROUTE 6
COLUMBIA CT
06237-1125
US

IV. Provider business mailing address

1007 N MAIN ST PO BOX 839
DAYVILLE CT
06241-2170
US

V. Phone/Fax

Practice location:
  • Phone: 860-228-4480
  • Fax: 860-228-6921
Mailing address:
  • Phone: 860-774-2020
  • Fax: 860-774-0826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: