Healthcare Provider Details

I. General information

NPI: 1982089181
Provider Name (Legal Business Name): MARY CILIO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 SAMP MORTAR DRIVE
FAIRFIELD CT
06824
US

IV. Provider business mailing address

173 SAMP MORTAR DRIVE
FAIRFIELD CT
06824
US

V. Phone/Fax

Practice location:
  • Phone: 203-372-2949
  • Fax:
Mailing address:
  • Phone: 203-372-2949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: