Individual
ETHAN SANSOLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
407 HIGHLAND AVE, BUILDING A, SUITE 6, CHESHIRE, CT 06410
(860) 335-7615
Mailing address
45 JIMMY LN, MERIDEN, CT 06450-7200
(203) 440-2351
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
58.008167
CT
Other
Enumeration date
12/06/2012
Last updated
12/06/2012
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