Provider Demographics
NPI:1124387972
Name:GRIFFIN-SERGEL, AMANDA R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:R
Last Name:GRIFFIN-SERGEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:R
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:95 THOMASTON AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-1007
Mailing Address - Country:US
Mailing Address - Phone:203-805-5300
Mailing Address - Fax:
Practice Address - Street 1:95 THOMASTON AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1007
Practice Address - Country:US
Practice Address - Phone:203-805-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0076771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical