Provider Demographics
NPI:1811363914
Name:FEDERICI, THERESA (EDD, LCSW,LMSW)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:FEDERICI
Suffix:
Gender:F
Credentials:EDD, LCSW,LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 EAST AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5020
Mailing Address - Country:US
Mailing Address - Phone:203-529-1602
Mailing Address - Fax:
Practice Address - Street 1:91 EAST AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5020
Practice Address - Country:US
Practice Address - Phone:203-529-1602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT31571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical