Provider Demographics
NPI:1639220544
Name:SLOAN, JOAN S (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:S
Last Name:SLOAN
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 6284
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-0284
Mailing Address - Country:US
Mailing Address - Phone:203-258-3445
Mailing Address - Fax:203-646-6612
Practice Address - Street 1:451 STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3070
Practice Address - Country:US
Practice Address - Phone:203-258-3445
Practice Address - Fax:203-646-6612
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0050981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040572OtherEDS NUMBER
CT004266624Medicaid
CT1326107376OtherORGANIZATION NPI NUMBER