Individual
GWENDOLYN WAYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, CMTPT, LMT
Contact information
Practice address
17 OLD HICKORY LN, BRANFORD, CT 06405-2827
(203) 488-6411
Mailing address
PO BOX 515, BRANFORD, CT 06405-0515
(203) 488-6411
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8668
CT
225400000X
Rehabilitation Practitioner
000394
CT
Other
Enumeration date
09/12/2013
Last updated
03/09/2015
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