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General NPI Number Information
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NPI Number | 1710574835
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Entity Type | Organization
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Legal Business Name | JOSE AVILA LLC
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Dates
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Enumeration Date | 12/22/2020
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 100 PEARL ST FL 14
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City | HARTFORD
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State | CT
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Zip | 06103-4500
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Country | US
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Telephone | 860-785-0590
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Fax |
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Provider Business Mailing Address
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Address Line | 122 ARNOLD ST
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City | HARTFORD
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State | CT
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Zip | 06106-3507
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Country | US
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Telephone | 860-785-0590
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Fax |
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Authorized Official
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Title or Position | LCSW/CEO
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Name | MR. JOSE ANGEL AVILA JR.
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Credential | LCSW
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Telephone | 860-785-0590
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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 |
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License Number State |
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