Healthcare Provider Details

I. General information

NPI: 1518050434
Provider Name (Legal Business Name): CATHERINE MARIE EWING LCSW, MDIV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9A PASCO DR
EAST WINDSOR CT
06088-1700
US

IV. Provider business mailing address

9A PASCO DR
EAST WINDSOR CT
06088-1700
US

V. Phone/Fax

Practice location:
  • Phone: 860-899-1220
  • Fax: 860-838-6460
Mailing address:
  • Phone: 860-899-1220
  • Fax: 860-838-6460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCT001969
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: