Provider Demographics
NPI:1730285313
Name:TAGLIAFERRO, SANDRA L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:TAGLIAFERRO
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 1:121 LOGGING TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-2627
Mailing Address - Country:US
Mailing Address - Phone:203-942-2343
Mailing Address - Fax:203-942-2343
Practice Address - Street 1:121 LOGGING TRAIL RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-2627
Practice Address - Country:US
Practice Address - Phone:203-942-2343
Practice Address - Fax:203-942-2343
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0052301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD300028265Medicare PIN