1588117469 NPI number — SANDRA E FERRUCCI, LCSW, LLC

Table of content: (NPI 1588117469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588117469 NPI number — SANDRA E FERRUCCI, LCSW, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDRA E FERRUCCI, LCSW, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PEACEWORKS COUNSELING & THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588117469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 MATTHEW CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06443-2175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-851-2495
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 WALL ST # 22
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06443-3121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-851-2495
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
FERRUCCI
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
ELAINE
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
203-851-2495

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com