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General NPI Number Information
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NPI Number | 1669872743
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Entity Type | Individual
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Provider Name | CARLY SUNDEL LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/26/2014
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 1177 SILAS DEANE HWY STE 3
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City | WETHERSFIELD
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State | CT
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Zip | 06109-4332
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Country | US
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Telephone | 860-837-0401
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Fax |
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Provider Business Mailing Address
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Address Line | 107G FENN RD
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City | NEWINGTON
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State | CT
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Zip | 06111-2250
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Country | US
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Telephone | 860-580-9883
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 010227
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License Number State | CT
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10227
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License Number State | CT
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