Healthcare Provider Details

I. General information

NPI: 1629517610
Provider Name (Legal Business Name): VALERIE TOMO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 VAUXHALL ST
NEW LONDON CT
06320-5711
US

IV. Provider business mailing address

400 COLUMBUS AVENUE CREDENTIALING SPECIALIST
NEW HAVEN CT
06519-1233
US

V. Phone/Fax

Practice location:
  • Phone: 860-442-2797
  • Fax: 860-701-3776
Mailing address:
  • Phone: 203-503-3174
  • Fax: 203-503-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10344
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: