Healthcare Provider Details

I. General information

NPI: 1194021758
Provider Name (Legal Business Name): DAISY SANTIAGO-LEVASSEUR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 THOMASTON AVE
WATERBURY CT
06702-1007
US

IV. Provider business mailing address

95 THOMASTON AVE
WATERBURY CT
06702-1007
US

V. Phone/Fax

Practice location:
  • Phone: 203-805-5300
  • Fax: 203-805-5310
Mailing address:
  • Phone: 203-805-5300
  • Fax: 203-805-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007062
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: