MEDICARE: DARLENE WHITE LCSW LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1396411393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DARLENE WHITE LCSW LLC

Provider Business Mailing Address
First Line	:	29 MAPLE ST UNIT 205
Second Line	:
City	:	SEYMOUR
State	:	CT
Zip	:	06483-3352
Country	:	US
Telephone Number	:	203-490-8565
Fax Number	:

Provider Business Practice Location Address
First Line	:	29 MAPLE ST UNIT 205
Second Line	:
City	:	SEYMOUR
State	:	CT
Zip	:	06483-3352
Country	:	US
Telephone Number	:	203-916-4594
Fax Number	:

Authorized Official
Title or Position	:	CLINICIAN
Name	:	DARLENE WHITE
Credential	:	LCSW
Telephone Number	:	203-916-4594

Provider Enumeration Date	:	08/19/2021
Last Update Date	:	08/19/2021

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