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Organization
TERESE FAGAN LCSW LLC
Active
Organization
TERESE FAGAN LCSW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESE BALLET (LICENSED CLINICAL SOCIAL WORKER)
(860) 778-3304
Entity
Organization
Contact information
Practice address
45 S MAIN ST, SUITE 107, WEST HARTFORD, CT 06107-2441
(860) 778-3304
Mailing address
1131 TOLLAND TPKE, UNIT 258, MANCHESTER, CT 06042-1679
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
008738
CT
Other
Enumeration date
10/04/2016
Last updated
10/04/2016
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