Provider Demographics
NPI:1073565438
Name:MECCA, WILLIAM JR (LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:MECCA
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4033
Mailing Address - Country:US
Mailing Address - Phone:203-257-3181
Mailing Address - Fax:203-375-1999
Practice Address - Street 1:4 WHITNEY EXTENTION
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880
Practice Address - Country:US
Practice Address - Phone:203-257-3181
Practice Address - Fax:203-375-1999
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000574101YA0400X
CT003871104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker