Healthcare Provider Details

I. General information

NPI: 1477338416
Provider Name (Legal Business Name): MORGAN LOURA DECARLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 WOODLAND ST
HARTFORD CT
06105-2363
US

IV. Provider business mailing address

101 KNOLLWOOD RD
ROCKY HILL CT
06067-1160
US

V. Phone/Fax

Practice location:
  • Phone: 888-793-3500
  • Fax:
Mailing address:
  • Phone: 860-543-2454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: