Healthcare Provider Details

I. General information

NPI: 1083813133
Provider Name (Legal Business Name): ELIZABETH SOUCY MENDES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 NORTH ST
WILLIMANTIC CT
06226-2528
US

IV. Provider business mailing address

18 PATRIOT RD
WINDHAM CT
06280-1424
US

V. Phone/Fax

Practice location:
  • Phone: 860-450-0151
  • Fax: 860-450-7152
Mailing address:
  • Phone: 860-208-6681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number008462
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: