Healthcare Provider Details

I. General information

NPI: 1740920669
Provider Name (Legal Business Name): NAKEEMA NORWOOD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 CONNECTICUT BLVD
EAST HARTFORD CT
06108-3013
US

IV. Provider business mailing address

190 PINE ST APT 104
MANCHESTER CT
06040-5894
US

V. Phone/Fax

Practice location:
  • Phone: 860-528-1359
  • Fax:
Mailing address:
  • Phone: 860-281-3942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12090
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: