Healthcare Provider Details

I. General information

NPI: 1811357965
Provider Name (Legal Business Name): CT SOCIALWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 GREYSTONE ROAD EXT
PLYMOUTH CT
06782-2900
US

IV. Provider business mailing address

70 GREYSTONE ROAD EXT
PLYMOUTH CT
06782-2900
US

V. Phone/Fax

Practice location:
  • Phone: 203-660-7459
  • Fax: 860-760-6122
Mailing address:
  • Phone: 203-660-7459
  • Fax: 860-760-6122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NATALENA BLOCK
Title or Position: DIRECTOR
Credential: LCSW
Phone: 203-660-7459