Organization
CHANGE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHELLY LICKWAR LCSW (CLINICAL DIRECTOR)
(860) 346-0771
Entity
Organization
Contact information
Practice address
1251 S MAIN ST, MIDDLETOWN, CT 06457-5050
(860) 346-0771
(860) 346-0772
Mailing address
1251 S MAIN ST, MIDDLETOWN, CT 06457-5050
(860) 346-0771
(860) 346-0772
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
3737
CT
Other
Enumeration date
04/17/2017
Last updated
04/17/2017
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