Provider Demographics
NPI:1669819645
Name:MIASEK, ROBIN MATTIELLO (MSW)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:MATTIELLO
Last Name:MIASEK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3709
Mailing Address - Country:US
Mailing Address - Phone:860-480-6465
Mailing Address - Fax:
Practice Address - Street 1:235 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3709
Practice Address - Country:US
Practice Address - Phone:860-480-6465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0087101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical