Provider Demographics
NPI:1346761400
Name:PAGE, CHERYL (LMSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 W STAFFORD RD STE II
Mailing Address - Street 2:
Mailing Address - City:STAFFORD SPRINGS
Mailing Address - State:CT
Mailing Address - Zip Code:06076-1000
Mailing Address - Country:US
Mailing Address - Phone:860-684-5015
Mailing Address - Fax:860-684-3749
Practice Address - Street 1:72 W STAFFORD RD STE II
Practice Address - Street 2:
Practice Address - City:STAFFORD SPRINGS
Practice Address - State:CT
Practice Address - Zip Code:06076-1000
Practice Address - Country:US
Practice Address - Phone:860-684-5015
Practice Address - Fax:860-684-3749
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3821104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker