Healthcare Provider Details

I. General information

NPI: 1760004212
Provider Name (Legal Business Name): JENNIFER LANCZYCKI AUGER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 OLD STONE XING
WEST SIMSBURY CT
06092-2820
US

IV. Provider business mailing address

21 OLD STONE XING
WEST SIMSBURY CT
06092-2820
US

V. Phone/Fax

Practice location:
  • Phone: 860-413-2294
  • Fax:
Mailing address:
  • Phone: 860-413-2294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2004
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: