Individual
CAROLYN MANGIAFICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
769 NEWFIELD ST, MIDDLETOWN, CT 06457-1846
(860) 575-1671
Mailing address
16 SAYBROOK RD, ESSEX, CT 06426-1401
(860) 575-1671
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
4009
CT
1041C0700X
Clinical Social Worker
Primary
004009
CT
1041C0700X
Clinical Social Worker
4009
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
CT
Enumeration date
08/13/2018
Last updated
08/13/2018
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