Individual
MR. KENNETH MICHAEL LACILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
476 HOWE AVE, SUITE 4, SHELTON, CT 06484-3153
(203) 924-9426
Mailing address
41 APPLETREE LN, NORTH HAVEN, CT 06473-2903
(203) 288-7943
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
004908
CT
Other
Enumeration date
05/11/2007
Last updated
07/08/2007
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