Healthcare Provider Details

I. General information

NPI: 1235207846
Provider Name (Legal Business Name): REBEKAH HAFFORD MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 MANSFIELD AVE
WILLIMANTIC CT
06226-2027
US

IV. Provider business mailing address

101 SOUTH ST UNIT # 71
VERNON CT
06066-4410
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-2261
  • Fax: 860-450-7116
Mailing address:
  • Phone: 860-454-4484
  • Fax: 860-450-7116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: