Healthcare Provider Details

I. General information

NPI: 1891537841
Provider Name (Legal Business Name): ABIGAIL FACEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 WOODLAND ST
HARTFORD CT
06105-2363
US

IV. Provider business mailing address

43 WOODLAND ST
HARTFORD CT
06105-2363
US

V. Phone/Fax

Practice location:
  • Phone: 860-793-3500
  • Fax:
Mailing address:
  • Phone: 860-793-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9969
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: