Provider Demographics
NPI:1629132824
Name:QUIJANO, SOFIA (LCSW)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:QUIJANO
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 1:93 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-3012
Mailing Address - Country:US
Mailing Address - Phone:860-223-6237
Mailing Address - Fax:
Practice Address - Street 1:871 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3923
Practice Address - Country:US
Practice Address - Phone:203-787-2111
Practice Address - Fax:203-397-9077
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0057551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB000698OtherDMHAS
CT329553OtherVALU OPT CHN CT SAGA
CTCTGA000525OtherDMHAS
CT329553OtherVALU OPT CHN CT SAGA