Provider Demographics
NPI:1831112424
Name:ABBOTT, DAISY (LCSW)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DAISY
Other - Middle Name:
Other - Last Name:ABBOTT SLETCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:575 MAIN ST FL 2
Mailing Address - Street 2:ATTN: CREDENTIALING DEPARTMENT
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2845
Mailing Address - Country:US
Mailing Address - Phone:860-347-6971
Mailing Address - Fax:860-704-8034
Practice Address - Street 1:675 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-2718
Practice Address - Country:US
Practice Address - Phone:860-347-6971
Practice Address - Fax:860-704-8034
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0077701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008035232Medicaid