Healthcare Provider Details

I. General information

NPI: 1205097300
Provider Name (Legal Business Name): HANNAH C LEITERMAN M.A., L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 BOSTON POST RD ERRERA COMMUNITY CARE CENTER
WEST HAVEN CT
06516-2043
US

IV. Provider business mailing address

114 BOSTON POST RD ERRERA COMMUNITY CARE CENTER
WEST HAVEN CT
06516-2043
US

V. Phone/Fax

Practice location:
  • Phone: 203-479-8031
  • Fax: 203-479-8001
Mailing address:
  • Phone: 203-479-8031
  • Fax: 203-479-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number006778
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: