Provider Demographics
NPI:1760823991
Name:HIROTA, WAKANA (LCSW)
Entity Type:Individual
Prefix:
First Name:WAKANA
Middle Name:
Last Name:HIROTA
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 1:1090 ELM ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1849
Mailing Address - Country:US
Mailing Address - Phone:860-384-9477
Mailing Address - Fax:
Practice Address - Street 1:1090 ELM ST
Practice Address - Street 2:SUITE 104
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1849
Practice Address - Country:US
Practice Address - Phone:860-384-9477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0080581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical