Healthcare Provider Details

I. General information

NPI: 1336223486
Provider Name (Legal Business Name): MARYBETH METELSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 HOSPITAL AVE
DANBURY CT
06810-6021
US

IV. Provider business mailing address

84 HOSPITAL AVE
DANBURY CT
06810-6021
US

V. Phone/Fax

Practice location:
  • Phone: 203-792-6060
  • Fax: 203-794-9556
Mailing address:
  • Phone: 203-792-6060
  • Fax: 203-794-9556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number006321
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: