Provider Demographics
NPI:1619328713
Name:WOLFGANG-PINTO, YANIRA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:YANIRA
Middle Name:
Last Name:WOLFGANG-PINTO
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 1:983 MAIN ST STE 12
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6018
Mailing Address - Country:US
Mailing Address - Phone:860-817-5607
Mailing Address - Fax:860-216-1172
Practice Address - Street 1:983 MAIN ST STE 12
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6018
Practice Address - Country:US
Practice Address - Phone:860-817-5607
Practice Address - Fax:860-216-1172
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0094801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical