Individual
HEATHER R LASELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD ABD, LCSW,MPA,MS
Contact information
Practice address
176 ROBIN LN, CHESHIRE, CT 06410
(203) 599-1492
Mailing address
416 HIGHLAND AVE STE B, CHESHIRE, CT 06410-2531
(203) 599-1492
(203) 433-0669
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8867
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008057449
—
CT
01
—
PENDING
CAQH
—
Enumeration date
03/05/2013
Last updated
01/11/2020
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