Healthcare Provider Details

I. General information

NPI: 1578625067
Provider Name (Legal Business Name): ICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 ELM ST
NAUGATUCK CT
06770-4127
US

IV. Provider business mailing address

35 ELM ST
NAUGATUCK CT
06770-4127
US

V. Phone/Fax

Practice location:
  • Phone: 203-723-4133
  • Fax: 203-723-4202
Mailing address:
  • Phone: 203-723-4133
  • Fax: 203-723-4202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004892
License Number StateCT

VIII. Authorized Official

Name: MS. STACY MARIE PROPFE
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential: LCSW
Phone: 203-723-4133