Individual
MR. EDWIN G TAETSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
21 MONTAUK AVE, NEW LONDON, CT 06320-4906
(860) 439-6400
Mailing address
21 MONTAUK AVE, NEW LONDON, CT 06320-4906
(860) 439-6400
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
2002025562
MO
1041C0700X
Clinical Social Worker
Primary
9037
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008065427
—
CT
05
—
200912137
—
MO
05
—
469004813
—
MO
Enumeration date
07/26/2006
Last updated
12/13/2018
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