Individual
MS. ELIZABETH V. MODUGNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
8 MYRTLE AVE, WESTPORT, CT 06880-3511
(203) 383-0501
Mailing address
8 MYRTLE AVE, WESTPORT, CT 06880-3511
(203) 383-0501
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
007974
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004041000
—
CT
05
—
008003745
—
CT
05
—
008042700
—
CT
Enumeration date
12/07/2010
Last updated
05/23/2013
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