Provider Demographics
NPI:1124379797
Name:GARGANO, JAMIE ANNE (MSW)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:ANNE
Last Name:GARGANO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 PRESTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450
Mailing Address - Country:US
Mailing Address - Phone:203-317-2700
Mailing Address - Fax:203-317-2893
Practice Address - Street 1:558 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2100
Practice Address - Country:US
Practice Address - Phone:203-715-7818
Practice Address - Fax:203-715-7818
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CT101181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker