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General NPI Number Information
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NPI Number | 1902439904
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Entity Type | Individual
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Provider Name | ELIZABETH JANE CARLUCCI LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 94 ISAIAH SMITH LN
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City | MORRIS
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State | CT
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Zip | 06763-1506
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Country | US
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Telephone | 860-459-4115
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Fax |
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Provider Business Mailing Address
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Address Line | 17 OLD PARKWOOD RD
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City | NEW MILFORD
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State | CT
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Zip | 06776-2617
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Country | US
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Telephone | 203-482-1224
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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 | 007061
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License Number State | CT
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