Healthcare Provider Details

I. General information

NPI: 1871958173
Provider Name (Legal Business Name): LINDSEY MONIQUE DESORBO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41C NEW LONDON TPKE
GLASTONBURY CT
06033-4206
US

IV. Provider business mailing address

41C NEW LONDON TPKE STE 4
GLASTONBURY CT
06033-4209
US

V. Phone/Fax

Practice location:
  • Phone: 475-331-9065
  • Fax:
Mailing address:
  • Phone: 475-331-9065
  • Fax: 855-978-1719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number011441
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: