Provider Demographics
NPI:1457663841
Name:HOSPOD, STANLEY H III (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:H
Last Name:HOSPOD
Suffix:III
Gender:M
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:PO BOX 226
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:CT
Mailing Address - Zip Code:06350-0226
Mailing Address - Country:US
Mailing Address - Phone:860-377-3838
Mailing Address - Fax:
Practice Address - Street 1:8 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357
Practice Address - Country:US
Practice Address - Phone:860-377-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CT83631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty