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NPI Code Detail

MEDICARE: MRS. CAROL W. CEDERBAUM MSW, LCSW

MEDICARE:  MRS. CAROL W. CEDERBAUM  MSW, LCSW
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
11041C0700XClinical Social Worker000919CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1140000919CT01OTHERCTANTHEM BLUE CROSS

General Provider Information

NPI Number : 1578625604
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CAROL W. CEDERBAUM MSW, LCSW
Provider Business Mailing Address
First Line : 57 PARTRICK RD
Second Line :
City : WESTPORT
State : CT
Zip : 06880-1920
Country : US
Telephone Number : 203-227-9478
Fax Number : 203-227-6587
Provider Business Practice Location Address
First Line : 666 GLENBROOK RD
Second Line :
City : STAMFORD
State : CT
Zip : 06906-1439
Country : US
Telephone Number : 203-359-3321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2006
Last Update Date : 07/08/2007

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