Healthcare Provider Details

I. General information

NPI: 1396527149
Provider Name (Legal Business Name): MORGAN GAWLAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1297 E PUTNAM AVE STE 1006
RIVERSIDE CT
06878-1500
US

IV. Provider business mailing address

16 LIANDINA RD
WALLINGFORD CT
06492-4905
US

V. Phone/Fax

Practice location:
  • Phone: 833-378-2162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14103
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: