Healthcare Provider Details

I. General information

NPI: 1881421907
Provider Name (Legal Business Name): STEPHANIE MARIE CAOUETTE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 HEMLOCK ST
MANCHESTER CT
06040-4066
US

IV. Provider business mailing address

93 HEMLOCK ST
MANCHESTER CT
06040-4066
US

V. Phone/Fax

Practice location:
  • Phone: 959-237-5759
  • Fax:
Mailing address:
  • Phone: 959-237-5759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number013024
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: