Provider Demographics
NPI:1497465462
Name:WYATT, JOY (LCSW)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:WYATT
Suffix:
Gender:F
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 1549
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-1549
Mailing Address - Country:US
Mailing Address - Phone:860-567-4437
Mailing Address - Fax:860-567-0300
Practice Address - Street 1:25 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-4005
Practice Address - Country:US
Practice Address - Phone:860-567-4437
Practice Address - Fax:860-567-0300
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0124891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical