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General NPI Number Information
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NPI Number | 1578482014
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Entity Type | Individual
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Provider Name | MEDARDO RAMON URDANETA PAULINO LMSW
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Gender | Male
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Dates
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Enumeration Date | 07/10/2026
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Last Update Date | 08/26/2026
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Provider Practice Location Address
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Address Line | 110 COURT ST STE 3
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City | CROMWELL
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State | CT
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Zip | 06416-1273
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Country | US
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Telephone | 860-613-9930
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Fax | 860-613-9952
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Provider Business Mailing Address
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Address Line | 465 EVERS ST
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City | BRIDGEPORT
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State | CT
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Zip | 06610-1304
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 132215
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 12373
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License Number State | CT
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