Healthcare Provider Details

I. General information

NPI: 1194160820
Provider Name (Legal Business Name): LAWRENCE CAFFREY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 WATER ST
DANIELSON CT
06239-2838
US

IV. Provider business mailing address

54 NORTH ST
WILLIMANTIC CT
06226-2528
US

V. Phone/Fax

Practice location:
  • Phone: 860-779-5852
  • Fax: 860-779-5000
Mailing address:
  • Phone: 860-450-7122
  • Fax: 860-450-7127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8247
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: