Provider Demographics
NPI:1497517296
Name:HASWELL, TRINITY
Entity Type:Individual
Prefix:
First Name:TRINITY
Middle Name:
Last Name:HASWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 REDDING ROAD, #807
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06829-0807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:65 REDDING ROAD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:CT
Practice Address - Zip Code:06829-0807
Practice Address - Country:US
Practice Address - Phone:203-583-0905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT136351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical