Individual
MRS. ELISE B. TROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
002446
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00412586200
—
CT
01
—
248294
MHN GROUP
CT
01
—
77ABH0020CT01
ANTHEM BEHAVIORAL HEALTH
CT
01
—
ANC1319
OXFORD PROVIDER PIN
CT
Enumeration date
03/28/2007
Last updated
02/07/2008
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