Individual
HALEEMAH LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
567 VAUXHALL STREET EXT STE 316, WATERFORD, CT 06385-4341
(860) 303-0336
Mailing address
PO BOX 526, NEW LONDON, CT 06320-0526
(860) 303-0336
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CT 004841
CT
Other
Enumeration date
09/17/2006
Last updated
07/08/2007
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