Provider Demographics
NPI:1083604698
Name:CECCARELLI-EGAN, JOANNE M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:M
Last Name:CECCARELLI-EGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 OLDE POND RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-3170
Mailing Address - Country:US
Mailing Address - Phone:860-676-1731
Mailing Address - Fax:860-674-9097
Practice Address - Street 1:31 COLTON ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2328
Practice Address - Country:US
Practice Address - Phone:860-676-1731
Practice Address - Fax:860-674-9097
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0007721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140000772CT03OtherBLUE CROSS
CT000772CTOtherSTATE LICENSE
CTP3067653OtherOXFORD INSURANCE
CT167261OtherMHN
CT140000772CT03OtherBLUE CROSS