Healthcare Provider Details

I. General information

NPI: 1689076630
Provider Name (Legal Business Name): SENIEL LUCIEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 FARMINGTON AVE. #5
W. HARTFORD CT
06119-1670
US

IV. Provider business mailing address

805 FARMINGTON AVE. #5
W. HARTFORD CT
06119-1670
US

V. Phone/Fax

Practice location:
  • Phone: 860-526-8109
  • Fax: 860-526-8109
Mailing address:
  • Phone: 860-526-8109
  • Fax: 860-526-8109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number000751
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number006341
License Number StateCT

VIII. Authorized Official

Name: SENIEL LUCIEN
Title or Position: OWNER/SOLE PROPRIETOR
Credential: LCSW, PH.D.
Phone: 860-526-8109