Healthcare Provider Details

I. General information

NPI: 1194445031
Provider Name (Legal Business Name): HALEY E KING LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N FRONTAGE RD
MANSFIELD CENTER CT
06250-1648
US

IV. Provider business mailing address

2 WATERSIDE XING STE 401
WINDSOR CT
06095-1588
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-2261
  • Fax: 860-450-1357
Mailing address:
  • Phone: 860-697-3351
  • Fax: 860-731-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7162
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: