MEDICARE: NANCY CIAVAGLIA LMFT

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	106H00000X	Marriage & Family Therapist	000817	CT

General Provider Information

NPI Number	:	1548313778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY CIAVAGLIA LMFT

Provider Business Mailing Address
First Line	:	511 NEW LONDON TPKE
Second Line	:
City	:	NORWICH
State	:	CT
Zip	:	06360-6552
Country	:	US
Telephone Number	:	860-886-9324
Fax Number	:	860-886-6182

Provider Business Practice Location Address
First Line	:	72 NEW LONDON TPKE
Second Line	:
City	:	NORWICH
State	:	CT
Zip	:	06360-2614
Country	:	US
Telephone Number	:	860-886-8122
Fax Number	:	860-889-7255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	02/07/2019

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