Healthcare Provider Details

I. General information

NPI: 1720211329
Provider Name (Legal Business Name): STILLPOINT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2009
Last Update Date: 08/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 COLONIAL RD
WATERTOWN CT
06795-3106
US

IV. Provider business mailing address

66 COLONIAL RD
WATERTOWN CT
06795-3106
US

V. Phone/Fax

Practice location:
  • Phone: 860-417-9119
  • Fax: 860-274-1418
Mailing address:
  • Phone: 860-417-9119
  • Fax: 860-274-1418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005715
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001668
License Number StateCT

VIII. Authorized Official

Name: LESLIE SWIDERSKI
Title or Position: VICE PRESIDENT
Credential: LCSW
Phone: 860-417-9119