=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467524348
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS A. LORENZETTI LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | COMMUNITY MENTAL HEALTH AFFILIATES, INC. 55 WINTHROP STREET
-----------------------------------------------------
City | NEW BRITAIN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-224-8192
-----------------------------------------------------
Fax | 860-827-3472
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35 RUSSELL ST
-----------------------------------------------------
City | NEW BRITAIN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06052-1312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-229-8887
-----------------------------------------------------
Fax | 860-229-8886
-----------------------------------------------------
=====================================================
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 | 006328
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------