Healthcare Provider Details

I. General information

NPI: 1255896064
Provider Name (Legal Business Name): DAGMARA NIECIKOWSKI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 RUSSELL ST
NEW BRITAIN CT
06052-1312
US

IV. Provider business mailing address

33 RENN LN
BERLIN CT
06037-3589
US

V. Phone/Fax

Practice location:
  • Phone: 860-348-3371
  • Fax: 860-612-0087
Mailing address:
  • Phone: 860-748-5644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DAGMARA NIECIKOWSKI
Title or Position: LCSW
Credential: LCSW
Phone: 860-348-3371