=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285883082
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA J TRIGILA LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2008
-----------------------------------------------------
Last Update Date | 10/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36 MAIN ST UNIT 8
-----------------------------------------------------
City | EAST HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06512-2524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-989-9504
-----------------------------------------------------
Fax | 203-672-1813
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38 WOODHAVEN RD
-----------------------------------------------------
City | ROCKY HILL
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06067-1045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-989-9504
-----------------------------------------------------
Fax | 203-891-5976
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 007408
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------