Provider Demographics
NPI:1760733786
Name:AGUILAR, FANNY ELENA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:FANNY
Middle Name:ELENA
Last Name:AGUILAR
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 1:401 W. THAMES ST
Mailing Address - Street 2:SOUTHEASTERN MENTAL HEALTH AUTHORITY, BLDG 301
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-859-4674
Mailing Address - Fax:860-859-4790
Practice Address - Street 1:401 W. THAMES ST.
Practice Address - Street 2:SOUTHEASTERN MENTAL HEALTH AUTHORITY, BLDG 301
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-859-4674
Practice Address - Fax:860-859-4790
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0075891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical