Healthcare Provider Details

I. General information

NPI: 1366039182
Provider Name (Legal Business Name): STEPHANIE CAROLINE CIARDELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2389 MAIN ST STE 100
GLASTONBURY CT
06033-4617
US

IV. Provider business mailing address

2389 MAIN ST STE 100
GLASTONBURY CT
06033-4617
US

V. Phone/Fax

Practice location:
  • Phone: 475-381-3149
  • Fax:
Mailing address:
  • Phone: 475-381-3149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: