Healthcare Provider Details

I. General information

NPI: 1467769752
Provider Name (Legal Business Name): MS. TANESHA S PICKARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 ALBANY AVE STE 203B
WEST HARTFORD CT
06117-2523
US

IV. Provider business mailing address

PO BOX 4172
WINDSOR LOCKS CT
06096-4172
US

V. Phone/Fax

Practice location:
  • Phone: 203-668-1718
  • Fax: 860-891-6263
Mailing address:
  • Phone: 203-668-1718
  • Fax: 860-891-6263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number1720798317
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number1720798317
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number1720798317
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1467769752
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1467769752
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1467769752
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: