Provider Demographics
NPI:1679846356
Name:NOLEN, CEPHUS JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CEPHUS
Middle Name:
Last Name:NOLEN
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WELLS ST
Mailing Address - Street 2:SUITE 2-L
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103
Mailing Address - Country:US
Mailing Address - Phone:860-756-8669
Mailing Address - Fax:860-293-0828
Practice Address - Street 1:100 WELLS ST
Practice Address - Street 2:SUITE 2-L
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-2928
Practice Address - Country:US
Practice Address - Phone:860-756-8669
Practice Address - Fax:860-293-0828
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-11
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0008871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical