Healthcare Provider Details

I. General information

NPI: 1710596747
Provider Name (Legal Business Name): DAVID ERNST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MECHANIC ST STE 2
WINDSOR CT
06095-2554
US

IV. Provider business mailing address

41 MECHANIC ST STE 2
WINDSOR CT
06095-2554
US

V. Phone/Fax

Practice location:
  • Phone: 860-920-4420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number58.014383
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: