Healthcare Provider Details

I. General information

NPI: 1871641266
Provider Name (Legal Business Name): MARGERY LEE CANFIELD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WEST THAMES STREET SOUTHEASTERN MENTAL HEALTH AUTHORITY BLDG 301
NORWICH CT
06360
US

IV. Provider business mailing address

401 WEST THAMES STREET SOUTHEASTERN MENTAL HEALTH AUTHORITY 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 Number001180
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: