Healthcare Provider Details

I. General information

NPI: 1811063597
Provider Name (Legal Business Name): LAURA LYTTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N MAIN ST
SOUTHINGTON CT
06489-2537
US

IV. Provider business mailing address

51 N MAIN ST
SOUTHINGTON CT
06489-2537
US

V. Phone/Fax

Practice location:
  • Phone: 203-988-8864
  • Fax: 203-439-0557
Mailing address:
  • Phone: 203-988-8864
  • Fax: 203-439-0557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002012
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: