Healthcare Provider Details

I. General information

NPI: 1205930989
Provider Name (Legal Business Name): SEAN P CRONIN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 WINSTED RD
TORRINGTON CT
06790-2958
US

IV. Provider business mailing address

16 HAVILAND RD
BLOOMFIELD CT
06002-3442
US

V. Phone/Fax

Practice location:
  • Phone: 860-496-3824
  • Fax: 860-496-3868
Mailing address:
  • Phone: 860-242-2312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005771
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: