Healthcare Provider Details

I. General information

NPI: 1124746961
Provider Name (Legal Business Name): NEDJINE MARCEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MERRITT BLVD
TRUMBULL CT
06611-5435
US

IV. Provider business mailing address

135 AUBURN ST
STRATFORD CT
06614-3745
US

V. Phone/Fax

Practice location:
  • Phone: 203-600-1417
  • Fax:
Mailing address:
  • Phone: 203-600-1417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13250
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: