NPI Code Details Logo

NPI 1528920618

NPI 1528920618 : ANGELA FRANCES CONKLIN LMSW : FAIRFIELD, CT

=====================================================
General NPI Number Information
=====================================================
    NPI Number           |    1528920618
-----------------------------------------------------
    Entity Type          |    Individual 
-----------------------------------------------------
    Provider Name        |    ANGELA FRANCES CONKLIN LMSW
-----------------------------------------------------
    Gender               |    Female 
-----------------------------------------------------

=====================================================
Dates
=====================================================
    Enumeration Date     |    11/26/2025
-----------------------------------------------------
    Last Update Date     |    11/26/2025
-----------------------------------------------------

=====================================================
Provider Practice Location Address
=====================================================
    Address Line         |    180 PALAMAR DR 
-----------------------------------------------------
    City                 |    FAIRFIELD
-----------------------------------------------------
    State                |    CT
-----------------------------------------------------
    Zip                  |    06825-2538
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    203-858-7644
-----------------------------------------------------
    Fax                  |    
-----------------------------------------------------

=====================================================
Provider Business Mailing Address
=====================================================
    Address Line         |    180 PALAMAR DR 
-----------------------------------------------------
    City                 |    FAIRFIELD
-----------------------------------------------------
    State                |    CT
-----------------------------------------------------
    Zip                  |    06825-2538
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    203-858-7644
-----------------------------------------------------
    Fax                  |    
-----------------------------------------------------

=====================================================
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       |    129402
-----------------------------------------------------
    License Number State |    NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
    Taxonomy Code        |    1041C0700X
-----------------------------------------------------
    Taxonomy Name        |    Clinical Social Worker
-----------------------------------------------------
    License Number       |    10953
-----------------------------------------------------
    License Number State |    CT
-----------------------------------------------------



                        

Copyright © 2007-2026 Data Labs Health. All rights reserved.