Healthcare Provider Details

I. General information

NPI: 1912539172
Provider Name (Legal Business Name): ROBIN VIGLIANI LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 ENFIELD ST
ENFIELD CT
06082-2903
US

IV. Provider business mailing address

707 ENFIELD ST
ENFIELD CT
06082-2903
US

V. Phone/Fax

Practice location:
  • Phone: 860-745-7144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11129
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: