Provider Demographics
NPI:1073142469
Name:SOCIAL WORK ENGAGEMENT SPECIALIST LLC
Entity Type:Organization
Organization Name:SOCIAL WORK ENGAGEMENT SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:P
Authorized Official - Last Name:FINCH
Authorized Official - Suffix:
Authorized Official - Credentials:DSW
Authorized Official - Phone:203-901-7340
Mailing Address - Street 1:3000 WHITNEY AVE # 215
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2353
Mailing Address - Country:US
Mailing Address - Phone:203-901-7340
Mailing Address - Fax:
Practice Address - Street 1:3000 WHITNEY AVE # 215
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2353
Practice Address - Country:US
Practice Address - Phone:203-901-7340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty