Healthcare Provider Details

I. General information

NPI: 1376941625
Provider Name (Legal Business Name): DENISA EMILIA CIUCCI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39A WATERBURY RD
PROSPECT CT
06712-1249
US

IV. Provider business mailing address

68 ROSEMOUNT AVE
WATERBURY CT
06708-3616
US

V. Phone/Fax

Practice location:
  • Phone: 203-758-3570
  • Fax:
Mailing address:
  • Phone: 203-707-7177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000023
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: