=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699281691
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEGAL SOCIAL WORK CONSULTANTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2017
-----------------------------------------------------
Last Update Date | 12/28/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35 BOSTON ST
-----------------------------------------------------
City | GUILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06437-2817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-988-3711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 FOX HILL DR
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06413-1016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-988-3711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RACHEL U MANEMEIT
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 203-988-3711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------