Provider Demographics
NPI:1639675671
Name:KAZLAUSKAS, REBECCA (LMSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KAZLAUSKAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:949 BRIDGEPORT AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3142
Mailing Address - Country:US
Mailing Address - Phone:203-878-6365
Mailing Address - Fax:203-301-2397
Practice Address - Street 1:949 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3142
Practice Address - Country:US
Practice Address - Phone:203-878-6365
Practice Address - Fax:203-301-2397
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003808104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004039244Medicaid