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General NPI Number Information
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NPI Number | 1619493152
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Entity Type | Organization
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Legal Business Name | MARY K WIMPFHEIMER, LLC
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 08/16/2017
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Provider Practice Location Address
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Address Line | 50 HARTFORD AVE
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City | GRANBY
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State | CT
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Zip | 06035-2306
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Country | US
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Telephone | 860-543-1203
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Fax |
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Provider Business Mailing Address
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Address Line | 18 RUSHFORD MEADE
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City | GRANBY
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State | CT
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Zip | 06035-2323
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Country | US
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Telephone | 860-643-1203
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Fax |
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Authorized Official
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Title or Position | LCSW,LLC
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Name | MARY WIMPFHEIMER
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Credential | LCSW
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Telephone | 860-543-1203
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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 | 006391
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License Number State | CT
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