Healthcare Provider Details

I. General information

NPI: 1275463267
Provider Name (Legal Business Name): CAROLYN KOERNER MANGIAFICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

954 MIDDLESEX TPKE
OLD SAYBROOK CT
06475-1302
US

IV. Provider business mailing address

1 GORHAM RD
CHESTER CT
06412-1324
US

V. Phone/Fax

Practice location:
  • Phone: 860-208-1026
  • Fax:
Mailing address:
  • Phone: 860-208-1026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. CAROLYN MANGIAFICO
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 860-208-1026