Healthcare Provider Details

I. General information

NPI: 1083743488
Provider Name (Legal Business Name): JOAN D. CAHILL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N MAIN ST STE. 2 D
SOUTHINGTON CT
06489-2537
US

IV. Provider business mailing address

PO BOX 401
SOUTHINGTON CT
06489-0401
US

V. Phone/Fax

Practice location:
  • Phone: 860-628-3963
  • Fax: 860-628-3966
Mailing address:
  • Phone: 860-628-3963
  • Fax: 860-628-3966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000271
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: