Healthcare Provider Details

I. General information

NPI: 1366085037
Provider Name (Legal Business Name): LAURA CENTURELLI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA CENTURELLI LCSW

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 BROAD ST
PLAINVILLE CT
06062-4201
US

IV. Provider business mailing address

21 TRAILSEND DR
CANTON CT
06019-2205
US

V. Phone/Fax

Practice location:
  • Phone: 860-856-5388
  • Fax:
Mailing address:
  • Phone: 860-459-7398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005303
License Number StateCT

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: