Healthcare Provider Details

I. General information

NPI: 1669102992
Provider Name (Legal Business Name): LIANE CYNTHIA GELMAN-WEGENER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 TRIANGLE ST # I-4
DANBURY CT
06810-6977
US

IV. Provider business mailing address

85 BLANCHARD RD
EASTON CT
06612-1933
US

V. Phone/Fax

Practice location:
  • Phone: 203-448-3200
  • Fax:
Mailing address:
  • Phone: 203-520-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005164
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: