Healthcare Provider Details

I. General information

NPI: 1255496576
Provider Name (Legal Business Name): MARYCAY WHEWELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WEST THAMES STREET BLDG 301
NORWICH CT
06360
US

IV. Provider business mailing address

401 WEST THAMES STREET BLDG 301
NORWICH CT
06360
US

V. Phone/Fax

Practice location:
  • Phone: 860-859-4674
  • Fax: 860-859-4790
Mailing address:
  • Phone: 860-859-4674
  • Fax: 860-859-4790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005606
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: