Healthcare Provider Details

I. General information

NPI: 1811083090
Provider Name (Legal Business Name): DEIRDRE PLYER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 EDMUND ST SUITE A
OLD SAYBROOK CT
06475-2422
US

IV. Provider business mailing address

35 EDMUND ST
OLD SAYBROOK CT
06475-2422
US

V. Phone/Fax

Practice location:
  • Phone: 860-304-1442
  • Fax:
Mailing address:
  • Phone: 860-853-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01684
License Number StateRI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6276508
Identifier TypeOTHER
Identifier StateRI
Identifier IssuerUNITED HEALTH
# 2
Identifier0000029639
Identifier TypeOTHER
Identifier StateRI
Identifier IssuerBLUE CROSS
# 3
Identifier0000412678
Identifier TypeOTHER
Identifier StateRI
Identifier IssuerBLUE CHIP
# 4
IdentifierDP56357
Identifier TypeMEDICAID
Identifier StateRI
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: