Provider Demographics
NPI:1417310673
Name:SPOONER, TAYLOR D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:D
Last Name:SPOONER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:TAYLOR
Other - Middle Name:D
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7720
Mailing Address - Street 2:CREDENTIALING SPECIALIST
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-0720
Mailing Address - Country:US
Mailing Address - Phone:203-503-3174
Mailing Address - Fax:203-503-3183
Practice Address - Street 1:400 COLUMBUS AVENUE
Practice Address - Street 2:CFG-COLUMBUS AVE
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1233
Practice Address - Country:US
Practice Address - Phone:203-503-3075
Practice Address - Fax:203-503-3066
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT99921041C0700X
CT000278104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235900Medicaid