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General NPI Number Information
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NPI Number | 1720211329
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Entity Type | Organization
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Legal Business Name | STILLPOINT
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Dates
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Enumeration Date | 08/29/2009
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Last Update Date | 08/29/2009
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Provider Practice Location Address
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Address Line | 66 COLONIAL RD
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City | WATERTOWN
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State | CT
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Zip | 06795-3106
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Country | US
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Telephone | 860-417-9119
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Fax | 860-274-1418
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Provider Business Mailing Address
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Address Line | 66 COLONIAL RD
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City | WATERTOWN
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State | CT
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Zip | 06795-3106
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Country | US
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Telephone | 860-417-9119
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Fax | 860-274-1418
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | LESLIE SWIDERSKI
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Credential | LCSW
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Telephone | 860-417-9119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 001668
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 005715
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License Number State | CT
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