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General NPI Number Information
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NPI Number | 1972821536
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Entity Type | Individual
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Provider Name | DAGMARA K. NIECIKOWSKI LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 45 RUSSELL ST
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City | NEW BRITAIN
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State | CT
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Zip | 06052-1312
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Country | US
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Telephone | 860-348-3371
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Fax |
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Provider Business Mailing Address
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Address Line | 33 RENN LN
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City | BERLIN
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State | CT
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Zip | 06037-3589
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Country | US
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Telephone | 860-748-5644
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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 | 007005
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License Number State | CT
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