Healthcare Provider Details

I. General information

NPI: 1750317673
Provider Name (Legal Business Name): YOHANNA CIFUENTES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EAST AVE
NORWALK CT
06851-5010
US

IV. Provider business mailing address

94D BLACHLEY RD
STAMFORD CT
06902-4320
US

V. Phone/Fax

Practice location:
  • Phone: 787-205-0643
  • Fax:
Mailing address:
  • Phone: 203-505-5793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number7899
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007647
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: