Healthcare Provider Details

I. General information

NPI: 1962042473
Provider Name (Legal Business Name): LENORE DWECK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 OLD KINGS HWY N
DARIEN CT
06820-4732
US

IV. Provider business mailing address

85 OLD KINGS HWY N
DARIEN CT
06820-4732
US

V. Phone/Fax

Practice location:
  • Phone: 203-202-7654
  • Fax:
Mailing address:
  • Phone: 203-202-7654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberCT883
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: