Healthcare Provider Details

I. General information

NPI: 1699608760
Provider Name (Legal Business Name): BETH CHERICO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 VALLEY RD
NEW CANAAN CT
06840-3899
US

IV. Provider business mailing address

355 CHICKADEE LN
STRATFORD CT
06614-2406
US

V. Phone/Fax

Practice location:
  • Phone: 866-542-4455
  • Fax: 203-966-3841
Mailing address:
  • Phone: 917-743-5909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12265
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: