Healthcare Provider Details

I. General information

NPI: 1538267596
Provider Name (Legal Business Name): LAURA JEAN KASPROW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 DURHAM RD SUITE 31
MADISON CT
06443-2677
US

IV. Provider business mailing address

70 GREEN SPRINGS DR
MADISON CT
06443-2050
US

V. Phone/Fax

Practice location:
  • Phone: 203-245-1956
  • Fax:
Mailing address:
  • Phone: 203-245-6973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002864
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: