Healthcare Provider Details

I. General information

NPI: 1669623815
Provider Name (Legal Business Name): CAROL ANN SZYMASZEK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL ANN KELLY

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 HAYNES ST
MANCHESTER CT
06040-4131
US

IV. Provider business mailing address

71 HAYNES ST
MANCHESTER CT
06040-4131
US

V. Phone/Fax

Practice location:
  • Phone: 860-646-1222
  • Fax:
Mailing address:
  • Phone: 860-646-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number073025
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007928
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7928
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: