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General NPI Number Information
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NPI Number | 1437514585
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Entity Type | Organization
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Legal Business Name | GILLIAN TANZ LCSW LLC
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Dates
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Enumeration Date | 12/16/2015
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Last Update Date | 12/16/2015
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Provider Practice Location Address
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Address Line | 115 FILLOW ST APT 3
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City | NORWALK
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State | CT
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Zip | 06850-2842
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Country | US
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Telephone | 203-442-4144
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Fax |
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Provider Business Mailing Address
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Address Line | 116 MILE COMMON RD
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City | EASTON
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State | CT
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Zip | 06612-1506
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Country | US
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Telephone | 203-442-4144
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | GILLIAN TANZ
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Credential | LCSW
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Telephone | 203-442-4144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9027
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License Number State | CT
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