Healthcare Provider Details

I. General information

NPI: 1821773284
Provider Name (Legal Business Name): CLEMENTINA ROSE PECOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 ELM ST
NORTH HAVEN CT
06473-3285
US

IV. Provider business mailing address

550 ELM ST
NORTH HAVEN CT
06473-3285
US

V. Phone/Fax

Practice location:
  • Phone: 860-215-2567
  • Fax:
Mailing address:
  • Phone: 203-410-1378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number014283
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: